
<J> " o „ o ■ V %. 



Tirst Aid in Illness and Injury 



FIRST AID 



ILLNESS AND INJURY 

COMPRISED IN A SERIES OF CHAPTERS ON 

THE HUMAN MACHINE 

ITS STRUCTURE, ITS IMPLEMENTS OF REPAIR, AND 

THE ACCIDENTS AND EMERGENCIES 

TO WHICH IT IS LIABLE 



BY 

JAMES E. PILCHER, M.D., Ph.D. 

CAPTAIN IN THE MBOICAL DEPARTMENT OF THE UNITED STATES ARMY 






CHARLES SCRIBNER'S SONS 
1892 



tttl^ 



»1 



COPYRIGHT, 1892, BY 
CHARLES SCRIBNER'S SONS. 



CONTENTS 



Part I. — THE CONSTRUCTION OF THE HUMAN 
MACHINE 

Chapter I. The Covering- the Skin 

PAGE 

Its functions ; its composition ; its appendages 3 

Chapter II. The Padding— the Fat 

Its functions ; its varieties ; its appearance in the body 5 

Chapter. III. The Framework — the Bones 

Their function ; their composition ; their structure ; the skeleton ; 
their varieties ; the skull ; the teeth ; the spinal column ; the 
thorax; the shoulder ; the arm ; the hand ; the pelvis; the leg; 
the foot 6 

Chapter IV. The Hinges — the Joints 

Their function ; their varieties ; their composition ; ligaments ; 
synovial membrane ; cartilage 25 

Chapter V. The Moving Apparatus — the 
Muscles 

Their function ; their composition ; their action ; the motions pro- 
duced ; voluntary muscles; involuntary muscles; their forms; 
their attachments; tendons; the individual muscles 29 

vii 



Vlll CONTENTS 

Chapter VI. The Central Power— the Brain 
and Nerves 

PAGE 

Its functions ; its divisions ; cranial nerves ; spinal nerves; motor 
nerves ; sensory nerves ; nerve and brain srfbstance ; the parts 
of the brain ; its delicacy ; the spinal cord ; the sympathetic 
nerves ' 36 



Chapter VII. The Repair Apparatus — the 
Blood and its Circulation 

The function of the blood ; its composition ; the heart ; its compo- 
sition ; the blood-vessels ; the arteries ; the capillaries ; the 
veins ; the circulation ; the pulse ; the location of the indi- 
vidual arteries ; the situation of the individual veins ; blood 
glands 46 



Chapter VIII. The Speaking and Breathing 
Apparatus — the Larynx and the Lungs 

Its composition; the pharynx ; the epiglottis ; Adam's apple; the 
vocal cords ; the windpipe ; the bronchial tubes ; the lungs ; 
bi earning ; the effect of breathing on life 64 



Chapter IX. The Digestive Apparatus — the 
Stomach and Bowels 

Its function; the forms in which food is absorbed; chewing; 
saliva; the gullet ; the stomach ; the gastric juice ; the bowels ; 
the liver ; the pancreas or sweetbread ; the process of digestion 



Chapter X. The Waste Removers — the Ex- 
cretory Apparatus 

Their function ; the skin ; the lungs ; the rectum or lower bowel ; 

the kidneys ; the bladder . . 76 



PREFATORY NOTE 

The importance of a general knowledge of the steps to be 
taken immediately in order to prevent serious consequences 
from accident or injury is now everywhere recognized. In 
the preparation of this contribution to the literature of the 
subject, three objects have been kept in view : i . To strip 
the subject as far as possible of technicality. 2. To avoid 
dwelling upon procedures requiring medical experience for 
their application. 3. f ° make a distinction between essential 
points and details, which, while valuable, might be omitted 
without damage — accomplishing this by stating the impor- 
tant facts in large and the accessory points in small type. 

While it has been the author's aim to produce a text-book 
for civilian and military first-aid classes, he has also sought 
to provide a manual for quick reference in the emergencies, 
which arise not only before the soldier on detached service, 
the explorer or hunter in sparsely peopfed districts, and the 
dweller at a distance from medical service, but in the quiet 
household, the crowded factory, the overflowing streets, and 
everywhere that work is done and lives are lived ; for wherever 
humanity exists, the means of learning how to stay the 
arrival of impending death and how to afford relief to the 
suffering cannot fail to be of advantage. 

v 



VI PREFATORY NOTE 

In the effort to cover the ground as completely as possible, 
all available works bearing upon the subject have been exam- 
ined with great care. While it is impracticable to acknowl- 
edge in detail the assistance derived from so many sources — 
save, perhaps, Holder? s Osteology, EsmarclCs Surgeons Hand- 
book, and the U. S. Army Manual of Drill for the Hospital 
Corps, which is reprinted entire, with original illustrations, in 
connection with carrying the disabled — the author gladly 
takes this opportunity of acknowledging in general his indebt- 
edness to his many co-workers in teaching early aid in illness 
and injury, whose writings have been both suggestive and 
inspiring to him. 



CONTENTS IX 

Chapter XI. The Perceptive Apparatus — the 

Senses 

PAGE 

Touch; taste; the tongue; smell; the nose; hearing; the ear; 

sight; the eye . . 79 

Part II.— THE IMPLEMENTS OF REPAIR 

Chapter XII. Germs, their Action and its 
Control 

Micro-organisms ; their agency in producing disease and contami- 
nating wounds ; germicides ; antiseptics ; cleanliness ; individ- 
ual antiseptic agents 87 

Chapter XIII. Knots and Bandages 

The granny ; the reef knot ; the surgeon's knot ; the clove hitch ; 
bandages ; the triangular bandage ; the narrow arm-sling ; the 
broad arm-sling; the large arm-sling; the triangular bandage 
as applied to various parts ; the square bandage ; the four- 
tailed bandage ; the roller bandage — sizes and rules for its 
application ; individual uses of the roller ; the double-headed 
roller 90 

Chapter XIV. Dressings and Applications 

The compress ; antiseptic gauze ; other materials ; protective 
applications; the first dressing-packet; fixative applications; 
plasters ; emollient applications ; poultices ; moist fomenta- 
tions ; dry fomentations ; counter-irritants ; mustard-plaster ; 
spice-plaster 107 

Part III. — ACCIDENTS AND EMERGENCIES 

Chapter XV. How to Act at First 

Keep cool ; be prompt and quiet ; summon a doctor; keep crowds 
back, and give patient air ; observe situation and surround- 
ings ; place patient in comfortable position ; remove tight 
clothing; be careful about stimulants; method of examina- 
tion; indications of diseases; feigning 119 



X CONTENTS 

Chapter XVI. Bruises, Burns, and Freezing 

PAGH 

Bruises; definition; causes; symptoms; treatment; burns; defi- 
nition; causes; varieties; symptoms; treatment; sunburn; 
burning clothing ; freezing ; definition ; causes ; varieties ; 
symptoms ; treatment ; chilblains 125 

Chapter XVII. Wounds 

Definition ; varieties ; causes ; symptoms ; treatment ; possibilities 
of surgery; cleanliness; drawing edges together; dressing; 
torn wounds ; punctured wounds ; splinters ; fish-hooks and 
arrows ; gunshot wounds ; wounds of the chest ; wounds of the 
abdomen ; dangers of improper treatment ; process of healing ; 
poisoned wounds 133 

Chapter XVIII. Bleeding 

Definition ; varieties ; causes ; symptoms ; treatment ; clotting; 
blood-pressure ; bleeding from arteries ; twisting ; tying ; po- 
sition ; pressure; ligature of limbs; tourniquets; treatment of 
bleeding from individual arteries in detail ; bleeding from veins ; 
direct pressure in the wound; pressure below wound; eleva- 
tion ; bleeding from capillaries ; hot water ; pressure ; styptics ; 
spitting of blood; from the nose; from the mouth ; from the 
throat ; from the lungs ; nose-bleed ; internal bleeding in gen- 
eral ; secondary bleeding; special susceptibility to bleeding . 145 

Chapter XIX. Sprains and Dislocations 

Sprains ; definition ; causes ; symptoms ; treatment ; bones out of 
joint; definition; causes; symptoms; treatment; the fingers; 
the lower jaw ; the shoulder 168 

Chapter XX. Broken Bones 

Definition ; varieties ; causes ; symptoms ; treatment ; splints ; 
slings ; fractures of the skull ; fractures of the upper extremity ; 
fractures of the chest and spine ; fractures of the lower extremity 172 

Chapter XXI. Foreign Bodies 

In the eye; in the ear; in the nose; in the throat — choking . . 192 



CONTENTS XI 

Chapter XXII. Fainting 

PAGE 

Unconsciousness in general ; fainting ; shock ; stunning ; compres- 
sion of the brain ; apoplexy ; drunkenness ; sunstroke ; insen- 
sibility from poisoning ; insensibility from freezing 196 



Chapter XXIII. Fits 

Epileptic fits; hysterics; convulsions from kidney disease; chil- 
dren's fits 211 



Chapter XXIV. Smothering 

Definition ; causes ; restoring the breathing — artificial respiration ; 
Sylvester's method ; Marshall Hall's method ; Howard's meth- 
od ; drowning ; definition ; causes ; symptoms ; treatment ; 
Satterthwaite's method ; rescuing the drowning ; breaking 
through the ice; smothering by gases; smothering by press- 
ure on the chest ; smothering by strangling or hanging . . . 214 



Chapter XXV. Poisons 

Definition ; varieties ; symptoms ; treatment ; emetics ; poison ivy, 
oak, sumach ; poisoned wounds ; dog bites ; snake bites ; in- 
sect stings 226 



Chapter XXVI. Death 

Definition ; causes ; proofs 234 

Chapter XXVII. The Emergencies of the 
Battle-field 

Provisions for treatment ; medical officers ; company bearers ; hos- 
pital corps ; hospital stewards ; acting hospital stewards ; uni- 
forms ; equipment ; organization for national guard ; articles 
of Geneva Convention ; work on the line of battle ; at the first 
dressing stations ; at the ambulance station ; the field hospital ; 
permanent hospitals 236 



Xll CONTENTS 

Chapter XXVIII. Carrying the Disabled 

PAGE 

The U. S. Army litter ; necessity for definite system ; U. S. Army 
system: forming the detachment; inspection; muster; litter 
drill; with closed litter; with open or loaded litter; to load the 
litter ; position of patient on litter ; general directions ; to pass 
obstacles ; to load with reduced numbers ; to unload ; improvi- 
sation of litters ; carrying by one bearer ; carrying by two bear- 
ers ; to place a patient on horseback ; the travois ; the two- 
horse litter ; ambulance drill 243 

Part IV. — THE CARE OF THE HUMAN MACHINE 
Chapter XXIX. Sanitary Suggestions 

Dwellings ; ventilation ; disinfection ; heat ; corrosive sublimate ; 
chloride of lime; sulphur; deodorization ; cleanliness; cloth- 
ing ; chafing ; foot-soreness ; food 287 



Part I 

THE CONSTRUCTION OF THE HUMAN 
MACHINE 



Part I 

THE CONSTRUCTION OF THE HUMAN 
MACHINE 

The body of man is a machine of most complicated 
structure, containing thousands of distinct pieces and 
many different varieties of materials. For practical pur- 
poses it may be considered in eleven groups, it being 
understood that it is designed not to give a complete 
account of them, but merely to convey such a general 
idea of the various parts as may be requisite for under- 
standing the means of staying danger from the emergen- 
cies of illness and injury. The eleven groups are : 

i. The Covering — the skin. 

2. The Padding — the fat. 

3. The Framework — the bones. 

4. The Hinges — the joints. 

5. The Moving Apparatus — the muscles. 

6. The Central Power — the brain and nerves. 

7. The Repair Apparatus — the blood-vessels. 

8. The Speaking and Breathing Apparatus — the 

larynx and lungs. 

9. The Digestive Apparatus — the stomach and bow- 

els. 

10. The Waste Removers — the excretory apparatus. 

11. The Perceptive Apparatus — the senses. 



CHAPTER I 

THE COVERING -THE SKIN 

The first structure forms a covering for all the others. It 
may be compared with the sacking of which a bag is com- 
posed, which covers and protects the articles stored within it. 
As a rip or tear in the sacking exposes the contents of the 
bag to damage, so a cut or laceration of the skin subjects 
the structures underlying it to injury. In it terminate many 
of the nerves of sensation, and it is therefore a very important 
organ of touch. It is, moreover, a very efficient organ of 
excretion of fluid and gaseous waste products, throwing off 
under ordinary circumstances as much as two and a half 
pounds of fluid during a day. Those of its functions then 
which come under our observation are (i) enclosure of con- 
tained parts, (2) protection of subjacent organs, (3) the loca- 
tion of the sense of touch, and (4) excretion of certain waste 
products. 

The skin, simple though it seems to be, is a very complicated struc- 
ture, and not only contains many forms of the elements composing it 
but presents in its substance a number of organs of great importance to 
the maintenance of life and health. It is ordinarily considered in three 
layers, (1) the epidermis or cuticle, (2) the dermis or cutis, and (3) the 
subcutaneous cellular tissue. 

The epidermis or "scarf-skin" consists of successive layers of scaly 
particles, which are flattened and dried cells. These cells are techni- 
cally known as epithelium. They cover all surfaces of the body, both 
external and internal, lining alike the skin, mucous membrane, and se- 
rous membrane, and are of varying shapes. At some points, but a 
single layer of epithelial cells is found, while others present many. The 
number of cells may also be abnormally increased as in the callous 
spots on the hands of men engaged in heavy manual labor, or in warts 
which are local overgrowths of the epithelium forming the epidermis. 
The epidermis is well shown in a blister where it is elevated by a watery 
effusion. 

3 



CONSTRUCTION OF .THE HUMAN MACHINE 



The dermis or " true skin " is a tissue composed of closely interwoven 
strong fibres with an admixture of elastic fibres, containing in its meshes 
many vessels, nerves, and minute glands. Blood-vessels are very abun- 
dant here, and hemorrhage results from the slightest incision. Here 
also lie the ends of the nerves from which is derived the sense of touch. 
The subcutaneous cellular tissue, from its close relation to the 
skin, may properly be considered as a part of it; its composition is 

practically the same, the apparent 
difference being caused by the 
loose manner in which the fibrous 
material is interwoven into a more 
open fabric. Enclosed in its meshes 
and spaces are found the origins 
of many of the appendages of 
the skin, together with numerous 
masses of fat. 

The appendages of the skin 
are of two kinds, — modifications 
of the epidermis, and excretory 
glands. The hair and nails are, 
like warts and callosities, a local 
overgrowth of the epidermic epi- 
thelium, differing from them, how- 
ever, in not being abnormal and 
performing certain functions. 

The sweat and sebaceous glands 
are organs of excretion located in 
the subcutaneous cellular tissue, 
and opening externally by mi- 
croscopic twisted ducts passing 
through both the dermis and the 
epidermis. The former are the source of perspiration, while the latter 
produce a yellow unctuous matter somewhat resembling suet, the func- 
tion of which is the lubrication of the surface of the body. 

When this sebaceous matter collects and hardens in the unclosed 
ducts, forming a sort of plug, the external end of which is black, we 
have the "black heads," "worms," or "grubs," very commonly seen in 
the skin of the face. These plugs of sebaceous matter, which assume, 
when squeezed out, a worm-like form, with a head formed by the outer 
end blackened probably by dust — are not infrequently supposed by 
the ignorant to be actual worms. 

If, however, the external orifice of the duct be closed by any acci- 
dent, the sebaceous matter continues to collect behind the obstruction, 
distending the duct in all directions until a tumor known- as a wen, 
sometimes of considerable size, is formed. They are quite frequently 




Fig. I. — Section of skin, showing its 
layers and the origin of its appen- 
dages. 



THE PADDING THE FAT 5 

found in the scalp, where they produce a peculiar knobby appear- 
ance. 

The excretion of waste products, particularly by the sweat glands, is 
essential to life, and its diminution produces poisoning of the system, as 
is seen in the dry skin of fevers, while its entire cessation would produce 
early death. 



CHAPTER II 
THE PADDING — THE FAT 

Ix packing into the same receptacle articles of various 
shapes and sizes, some tender like ripe fruit, and others hard 
and stiff like blocks of wood, some sort of padding or filling 
is necessary to prevent mutual injury. This function is per- 
formed in the bodies of man and animals by the fat which 
fills in the interstices between the various parts. 

In addition to this, the fat serves as a reserve of nourish- 
ment upon which the system may draw in case of lack of 
ordinary means of nutrition. This function is familiar in 
cases of illness ; when the appetite is poor and but little food 
is absorbed into the system, the sick one grows thin because 
the small quantity of food taken is not sufficient to sustain 
him, and he is compelled to draw upon the reserve of fat 
stored up in the interstices of his system. 

Perhaps the most important function of the fat, however, 
is the maintenance and retention of the animal heat. Every 
one has observed that a stout person requires less clothing 
than a thin one, and this is due to the greater amount of fat 
underlying his skin. 

While this constituent has its advantages, it may also be 
the source of no little inconvenience in certain cases : it may 
choke up certain organs so as to interfere with their action, 
and, by mingling with the tissues of other organs, render 
them weak and inefficient ; it may also obscure adjacent tis- 
sues, as is seen in the case of a wounded artery in a stout 
person, where the fat renders it difficult to find the bleeding 



6 CONSTRUCTION OF THE HUMAN MACHINE 

vessel above the wound and interferes with proper compres- 
sion when it is found. 



There are three principal fats in the body, — stearin, palmitin, and 
olein. These all consist of glycerine, which is an alcohol, in combina- 
tion with a fatty acid, stearic, palmitic, or oleic, as the case may be. 
In the manufacture of soap, these acids set free the glycerine and 
combine instead with an alkali. 

Fat is ordinarily seen in the form of adi- 
pose tissue, which is formed by masses of 
minute vesicles consisting of an exceedingly 
delicate membrane filled with fatty matter and 
having an average diameter of s^u of an inch. 
These vesicles are grouped together and 
retained in place mainly by microscopic 
blood-vessels. The amount of adipose tissue 
in the body is subject to great variations ac- 
cording to its location, being entirely absent, 
for instance, in the brain and in the eyelids, 
while it is present in great abundance about 
the kidneys and other parts of the ab- 
domen. 




Fig. 2. — Adipose tissue 
magnified. 



CHAPTER III 



THE FRAMEWORK — THE BONES 



The bones form the framework about which are grouped 
the soft parts of which the body is otherwise composed. 
They also are designed for the protection of vital centres, as 
the brain is protected by the skull, and the heart and lungs 
are guarded from injury by the thorax. They consist of a 
hard, brittle substance, liable to become broken by sudden 
severe violence, but of sufficient strength to sustain any 
strain that may ordinarily be applied to them. 

Bones are composed of one-thud animal matter, principally gelatin 
and blood-vessels, and two-thirds mineral matter, carbonate, phosphate, 
and fluoride of lime, soda, common salt, and phosphate of magnesia. 

The mineral constituents of bone may be dissolved by chemical 
action, leaving behind only the gelatinous animal matter while still re- 



THE FRAMEWORK THE BONES 



7 




Fig. 3. — Bone, from which 
all mineral matter has been 
removed, tied in a knot. 



taining the original shape and dimensions of the bone. It may then 
be bent freely in all directions, and it is a common class-room ex- 
periment to tie into a knot a long bone so 
prepared. Similarly, the animal matter may 
be extracted by calcining or burning the 
bone. The proportion of animal to mineral 
matter is constant in the bones of the dead 
as well as the living, and it was this charac- 
teristic which enabled Gimbernat to make 
soup from a mastodon's tooth, and Buckland 
to obtain the body of a broth from fossil 
hyaena bones. 

The presence of animal matter contrib- 
utes to the toughness and elasticity of bone. 
In children this is particularly apparent — 
the latter quality rendering fractures far less 
frequent in proportion to the frequency of 
accidents, while the former accounts for the 

frequency of a mere bend in a child's bone where that of an adult 
would be broken. This characteristic is very notable in some of the 
lower animals. Arab children are said to make excellent bows of the 
ribs of camels, while the elasticity of the clavicle or "wish-bone" of 
fowls is familiar to every one. 

Microscopically, bone consists of concentric layers called lamellae, 
arranged about the course of a vascular or Haversian canal. Through- 
out these lamellae are minute 
cavities called lacunae, each 
containing a bone cell or osteo- 
blast, which influences the nutri- 
tive processes going on in the 
neighboring bone ; and diverg- 
ing from these cavities in every 
direction are minute canals or 
canaliculi, by which the lacunae 
are connected with one another 
and with the Haversian canals, 
providing free intercommunica- 
tion throughout the bone sub- 
stance for blood and lymphatic 
vessels. 
These elements unite to form two kinds of bone substance, — the 
ivory-like compact substa??ce seen for instance in the shaft of a long 
bone, and the spongy cancellous substance seen in its extremities. 

Both the structure and composition of bone are so arranged as to 
endue it with great strength, particularly remarkable as compared with 




Fig. 4. — The structure of bone 
magnified. 



8 CONSTRUCTION OF THE HUMAN MACHINE 

other substances. It has nearly four times the resisting power of lead 
and three times that of ash wood. A cubic inch of bone will support 
5000 pounds' weight. • Moreover, the structure of bone is such as to 
give it this strength with but little expenditure of materials. 

Bones are covered externally by the periosteum, a fibrous membrane 
in which run many blood-vessels, branching in all directions and sup- 
plying nutriment to the bone. Cavities in bone are similarly lined with 
a delicate membrane, the endosteum, and filled with 111 arrow. Both 
the periosteum and the endosteum contain many bone-forming cells, 
and fulfil a very important function in the formation, repair, and repro- 
duction of bone. 

The bones in the human body are two hundred in number, 
not counting the teeth and the small bones in the ears and 
in certain of the tendons. Taken together they constitute the 
skeleton, which weighs from twelve to fourteen pounds, the 
right side usually being a little heavier than the left. The 
points where the bones are joined to one another are called 
joints, and at these points a certain amount of motion is in- 
variably present, varying in extent from the extreme degree 
permitted at the shoulder to the almost imperceptible amount 
present in the pelvis. To this provision of the economy is 
due the ability to perform most of the functions of life. The 
condition of an individual with immovable joints, making the 
skeleton practically a single bone, would be deplorable in 
the extreme. He might live by the use of liquid food, but 
he could neither chew nor talk. He could not stand, because 
a certain amount of joint motion is necessary for the main- 
tenance of an erect posture. Continued disuse would cause 
his muscles to waste away, and he would be compelled to drag 
out a miserable existence, looking forward to death as a 
bearer of freedom to his imprisoned life. 

Bones are classed as long, short, flat, and irregular. A 
glance at the skeleton will emphasize the correctness of this 
classification. The bones of the arms and legs will readily 
be recognized as long bones. In the wrist and about the heel 
will be seen short bones. The shoulder-blade and the bones 
of the cranium are flat bones; while those composing the 
spinal column are distinctly irregular bones. 

The long bones serve as supports and levers for locomotion and lift- 
ing. They consist of a shaft, or body, and two extremities, articulating, 



THE SPINAL COLUMN AND THE SKULL Q 

or forming joints, with neighboring bones, and for this reason called 
articular extremities. In addition, they present various projections, 
called processes, which, it should be remarked, are found in most other 
bones ; they are mostly designed to afford additional surface for the 
attachment of muscles. 

The short bones are situated at points where strength and limited 
motion is desired. 

The flat bones are designed to protect important viscera, such as the 
brain, or to afford extensive surfaces for the attachment of muscles. 

In addition to the bones which are invariably present in the skeleton, 
are certain adventitious bones called Wormian bones and sesamoid 
bones. The former are irregular bits of bone, developed at points of 
the skull covered in infancy by membrane, the fontanelles, or " soft 
spots." Sesamoid bones are developed in the course of tendons, and 
contribute additional leverage to the muscles which terminate in these 
tendons. They are found in the tendons of the hand and foot. The 
patella, or " knee cap," is, in fact, a sesamoid bone, although, on 
account of its size, it is usually considered as a part of the skeleton 
proper. 

In the development of the body from the ovum, the first 
trace of the future skeleton, and almost the first evidence of 
the future individual, is a minute cellular cord called the noto- 
chord or corda dorsalis. The notochord occupies the place 
in which from this time the spine or vertebral column begins 
to be formed. Here appear ultimately the skull and the 
twenty-six bones forming the spinal column. 

The skull is the upper expansion of the spinal column. Its 
analogy to other parts of the spinal column may be very 
clearly traced. It is designed primarily to contain and pro- 
tect the brain, and its structure is marvellously adapted to 
these purposes. The skull is properly considered in two 
parts, the cranium, or brain-case, formed by eight bones, and 
the face, formed by fourteen bones, making a total of twenty- 
two bones, or a little more than one-tenth the number in the 
whole body. 

The cranium is a dome-like structure, the arching roof of 
which is so arranged as to decompose and disperse forces 
striking upon it, thus preventing their action upon the delicate 
brain substance contained in it. Were it not for this fortunate 
provision, injuries to the brain would occur much more fre- 
quently than they do. 



10 CONSTRUCTION OF THE HUMAN MACHINE 




Fig. 5. — The Skeleton, and its Reiation to the Contour of the Body. 



THE BONES OF THE SKULL 



II 



The bones of the cranium are : one frontal, forming the forehead 
and the arches over the eyes ; two parietal, covering the top and sides 
of the head, and separated from one another at the apex of the cranial 
vault; two temporal, occupying the temples on either side, and con- 
taining the organs of 



hearing; one occipital, 

occupying the lower back 
part of the cranium, 
which is called the occi- 
put, articulating with the 
spinal column, and con- 
taining the large aper- 
ture, or foramen mag- 
num, through which the 
spinal cord passes to 
join the brain ; one eth- 
moid, occupying the low- 
er anterior part of the 
cranium, and forming a 
part of the posterior 
chambers of the nose ; 
and one sphenoid, lying 
at the bottom of the 




Fig. 6. — The skull. 



cranium, wedged in between the other cranial bones; it derives its 
name from the Greek word meaning wedge, and forms the keystone 
to the cranial dome. 

The joints between the cranial bones are unlike those of the limbs, 
and almost entirely preclude movements of the bones in the child, and 
render them impossible in the adult. They consist of rows of tooth-like 
processes, which fit into corresponding depressions in the margins of 
the articulating bones, and are called sutures. There are eighteen of 
these, that between the two parietals being called the sagittal or arrow 
suture; that between the frontal and parietals being called the coronal 
or crown suture, that between the occipital and parietals being called 
lambdoid, from its resemblance to the Greek letter lambda, A ; while 
the others derive their names from the bones which they join. 

In infants, at the corners of the parietal bones, there are points not 
yet filled by bone, but covered by membrane. These are the " soft 
spots," and are called fontanelles. There are six of them. The lar- 
gest, the anterior fontanelle, lies just above the forehead, at the junction 
of the sagittal with the parietal suture, and remains open until not later 
than the second year ; the posterior fontanelle lies at the back of the 
head, at the junction of the sagittal and lambdoid sutures, and remains 
not filled by bone for several months after birth. The other four lie 
one before and one behind each ear. 



12 CONSTRUCTION OF THE HUMAN MACHINE 

The bones of the cranium present an external and internal table or 
layer of compact substance, with a layer of cancellous substance between 
them, called the diploe. Channelled in various directions throughout 
the diploe are many large and capacious veins, called the veins of the 
diploe. The internal table of the skull is remarkable for its brittleness, 
and for this reason is called the glass-like or vitreous table. Violence, 
insufficient to affect the tougher outer table, may break the inner table, 
so that a fracture of the inner face of a cranial bone may not be visible 
externally, even at the point where the violence was received. 

Hollowed out in each temporal bone is the cavity containing the 
organs of hearing, — an exceedingly complicated structure, with three 
chambers, three intrinsic bones, and many other important parts, to 
which reference will be made in the chapter on The Senses. 

The face owes its shape in a considerable degree to the 
bones, which aid in giving it beauty or ugliness. They de- 
termine the contour of the chin, the shape of the cheek, the 
height of the forehead, the size of the eyes, and the character 
of the nose. 

They also contribute to the formation of a number of cavi- 
ties, containing organs of the most vital importance to organ- 
ized life. The orbits contain, on either side, the organs of 
sight ; the nasal cavities are the site of the sense of smell ; 
the mouth or buccal cavity is the location of the sense of 
taste, and the first of the cavities in which the process of 
digesting food occurs. 

The bones of the face are : two superior maxillary, the upper jaw 
bones ; two malar, the cheek bones ; two nasal, forming the foundation 
of the nose; tw T o lachrymal, thin plates filling an opening in the orbit; 
two palate bones, attached to the rear of the superior maxillary, and 
continuing the bony roof of the mouth ; two inferior turbinated bones, 
forming the roof to the lower chamber of the nose ; one vomer, shaped 
like a ploughshare, and separating the lateral halves of the nose ; and 
one inferior maxillary bone, the lower jaw bone. 

The upper and lower jaw r s contain the teeth, the function 
of which is the reduction of food to fragments in order to 
permit the penetration of the digestive fluids. Every tooth 
presents a crown, or body projecting above the gum ; a neck, 
the constricted portion between the crown and the root ; and 
the root, or fang set into the jaw bone. Each tooth also 
contains a pulp cavity filled with tooth pulp. 



THE TEETH 



13 




The teeth are composed of four distinct structures. (1) The enamel 

forms the outer covering of the crown, and consists of six-sided parallel 

rods, about ^^ of an inch in diameter. It 

is the densest of all animal tissues and con- 
tains 96.5 per cent of mineral matter, which 

renders possible the use of the teeth in divid- 
ing even very hard foods. (2) The dentine, 

composing the greater part of the tooth, con- 
sists of wavy branching tubes called dental 

tubuli, about ^^ of an inch in diameter and 

embedded in a hard substance called the 

inter-tubular tissue. (3) In the pulp cavity 

lies the pulp, a soft cellular substance, very 

freely supplied with blood-vessels and nerves, 

which enter at the tip of the root. (4) The 

cement, or crusta petrosa, consists of true 

bone and forms the covering of the root of 

the tooth. 

The teeth appear in two crops: (1) the 

deciduous or milk teeth, ten in each jaw, and 

(2) the permanent teeth, sixteen in each jaw. 

The four front teeth are provided with a 

wedge-shaped crown and are adapted for 

cutting food, whence they are called incisors : 

they have but a single root. On either side of the incisors are the 

canines, so called from their resemblance to those of the dog. They 

are spear-shaped, and adapted for rending food, — an evidence of the 

carnivorous phase of man : they also 
have but one root. Those in the 
upper jaw are vulgarly known as 
" eve teeth " ; those in the lower 
jaw, as " stomach teeth." On either 
sides of these are two bicuspids or 
premolars, generally with a single 
root, and on either side of them 
are two molars or "grinders," with 
two or three roots. These teeth 
have a more or less cubical crown, 
the masticating surface of which is 
ridged to admit of the trituration 
or grinding of the food. The last 

molars are known as the "wisdom teeth." The molars represent the 

herbivorous phase of man. 

At birth, the teeth have not yet appeared, and it is not until from the 

fourth to the seventh month that the lower central incisors push their 



Fig. 7. — Structun 
a tooth, 




Fig. 8. — The teeth. 



14 CONSTRUCTION OF THE HUMAN MACHINE 



way through the gums, and are followed during the first two and a half 
years of life, in the order given, by the other incisors, the first molars, 
the canines, and the second molars. The eruption of the teeth through 
the gums — "teething" — is commonly attended by more or less dis- 
turbance of the system, varying from a slight indigestion to violent con- 
vulsions. Where the trouble is sufficient to demand interference, a 
slight cut in the gum over the coming tooth will relieve it. 

During the years following their appearance, in sacs at the roots of 
the deciduous teeth, a second set of teeth has been forming, which, as 
they grow, press upon the deciduous roots until they cause their entire 
absorption, leaving only the crowns, which are finally cast off, leaving 
room for the new permanent teeth. The first permanent teeth to appear 
are the first molars at the end of the sixth year, followed during the 
next six or seven years, in the order given, by the incisors, the bicuspids, 
the canines, and the second molars, while the appearance of the third 
molars or wisdom teeth is delayed until the age of seventeen to twenty- 
• one years. 

The spinal column or "backbone" con- 
sists not of a single bone, but of a chain of 
small bones called vertebrae so locked to- 
gether that the degree of motion between 
any two is limited, although that of the 
entire column is considerable. This gives 
it flexibility and permits the bending of the 
body. The cartilages between the verte- 
brae give it elasticity and prevent frequent 
stunning. At the same time it possesses 
great strength and firmness. It encloses 
and protects the spinal cord, forms a basis 
for the attachment of the muscles of the 
trunk and for those which maintain the 
body in the erect posture. Its bones 
are not arranged in a straight line, but in 
four gentle curves, which not only add 
greatly to the beauty of the contour, but 
very greatly increase its strength ; they also 
add to the elasticity of the spine and assist 
in the formation of the cavities for the lodge- 
ment of internal organs. 
There are seven cervical vertebrae, which enter into the 



Fig. 9. — The spinal 
column. 



THE SPINAL COLUMN 1 5 

neck ; twelve dorsal vertebrae, which enter into the chest, and 
from which spring the twelve ribs ; five lumbar vertebrae, 
forming the framework of the loins ; five sacral vertebrae, 
which are fused into a single bone, the sacrum or "rump 
bone, 11 which forms the keystone of the pelvis ; and four coc- 
cygeal vertebrae, also consolidated into a single bone, the 
coccyx, which forms the human rudimentary tail, and receives 
its name from its fancied resemblance to the beak of the 
cuckoo : the spinal column then, formed by thirty-three ver- 
tebrae, consists in reality of but twenty-six distinct bones. 
The cervical, dorsal, and lumbar vertebrae are called true ver- 
tebrae, and the sacral and coccygeal are called false vertebrae. 

Each vertebra consists of a main portion like a segment of a solid 
cylinder and called the body. From the back of this body spring two 
plates which meet and form an arch, the vertebral arch, circumscribing 
an aperture which is a segment of the spinal canal. It presents a num- 
ber of projections called processes, the chief of which springs from the 
posterior surface of the vertebral arch and is called the spinous process. 
The lowest cervical vertebra — the seventh — has a noticeably long 
spinous process, and for that reason is called the vertebra prominens. It 
can easily be felt at the base of the neck. Indeed, with the exception of 
those of the few upper vertebras of the neck, the spinous processes of 
all the vertebras can readily be felt, particularly if the body be bent 
forward and the arms drawn across the chest. Having identified the 
vertebra prominens by feeling, the others can readily be recognized by 
counting from it. It may be well to remark also that the seventh dorsal 
vertebra lies on a level with the lower angle of the shoulder blades, 
while the fourth lumbar vertebra is on a level with the highest point of 
the hip bones. 

Having become acquainted with the relations of the vertebras to the 
principal organs of the chest and belly, the knowledge of how to identify 
the vertebras renders it easy to discover what organs may probably have 
been injured in case of a wound of the body. In connection with the 
viscera (p. 143) will be found a table in which these relations are very 
clearly stated. 

The hunchback owes his hump to the fact that the bodies of certain 
of his vertebras have been worn away, rendering the curve of the back 
more pronounced, so as to make a prominence of greater or less size. 

Between the vertebras are certain elastic discs called the intervertebral 
cartilages, which act not only as buffers between the bones, but also as 
ligaments to hold them together. These discs yield to weight and flat- 
ten out to a slight extent ; even the weight of the head and body will 



l6 CONSTRUCTION OF THE HUMAN MACHINE 

have some effect upon them, so that every person is shorter when he 
retires at night than when he arises in the morning. They also yield 
in any direction to adapt themselves to any desired attitude; this 
yielding may become permanent and result in deformity, if a vicious 
attitude be habitually maintained, as in the one-sided attitude some- 
times assumed by the clerk who leans all day over his desk, or the 
stoop seen in the farmer who constantly bows over hoe or plough in 
his work. 

The first two cervical vertebrae, called respectively the atlas and the 
axis, are peculiar in that the atlas has no body, but is simply a ring of 
bone moving about an upward extension of the body of the axis. It is 
supposed that at first these vertebrae were like the others, but that in the 
evolution of the skeleton, in order to permit greater mobility of the 
head, the body of the first became fused with that of the second, form- 
ing the upward projection known as the odontoid process of the axis, 
and the first became the bony ring now known as the atlas, from its 
supporting the head as the mythical Atlas was wont to balance the 
earth on his shoulders. 

The atlas is joined directly to the skull, and the spinal canal at this 
point becomes continuous with the foramen magnum of the occipital 
bone. 

In front of the vertebras is a small horseshoe-shaped bone not 
attached to any other, called the hyoid 
bone. It lies just above the larynx, 
which may readily be felt in the neck, 
the front of it being known as the " Ad- 
am's apple." This bone is a very im- 
portant part of the foundation of the 
tongue, and also gives attachment to 
the muscles which give the contour to 
Fig. 10. — The hyoid bone. the chin. 

The thorax is a bony cage designed to contain and protect 
the heart and lungs. The foundation of the thorax is the 
dorsal portion of the spinal column. Passing out from each 
one of the dorsal vertebrae are the ribs, twelve on each side, 
ten of which turn again to become united with the sternum 
or " breast bone " in front by means of the costal cartilages, 
thus taking the shape of a sickle. The twenty-four ribs 
are known by their numbers on either side from top to bot- 
tom, the upper rib on either side being the first rib, right 
or left, etc. The eleventh and twelfth ribs, which are not 
attached to the sternum, are called " floating ribs." 




BONES OF THE CHEST AND SHOULDER 



17 




Fig. II. — The thorax. 



The sternum or " breast bone " is a flat bone from six to seven inches 
long, which was compared by the ancients to a sword, and considered 

in three pieces ; the upper they 
called the manubrium or handle, 
the middle and longest part is 
called the mucro or blade, while 
the third and smallest portion is 
called the ensiform appendix or 
sword-like appendage. 

The costal cartilages, to which 
reference will again be made under 
the head of Cartilage, are tough, 
elastic continuations of the ribs, con- 
necting them with the sternum and 
by their elasticity permitting move- 
ments of the chest in breathing, 
which would be impossible were 
the ribs and sternum joined directly 
together. This peculiarity will be fully considered in connection with 
the subject of breathing. 

The upper extremity consists of the shoulder, the arm, 
the forearm, and the hand, 
and is formed by the scapula, 
the clavicle, the humerus, the 
radius and ulna, the carpus, 
and the bones of the hand. 
The length of the upper ex- 
tremities should be exactly 
proportional to the height of 
the person. When the arms 
are outstretched in the same 
horizontal line, the distance 
between the tips of the mid- 
dle fingers should be equal to 
the height. 

The shoulder is formed by 
the scapula, the clavicle, and 
the upper end of the hu- 
merus. Fig. 12. — The shoulder blade. 

The scapula or " shoulder blade " is a broad, triangular, flat bone, 
which lies upon the upper back part of the thorax, covering the first 




1 8 CONSTRUCTION OF THE HUMAN MACHINE 



seven ribs. Its anterior surface is smooth and slightly concave, while 
from its posterior surface springs a sloping ridge known as the spine 
the outer apex of which — the acromion — projects over the shouldej 
joint to protect it and prevent the arm bone from slipping up. A< 
the outer angle is found a shallow cup facing outward, — the glenoid 
cavity, — which receives the rounded head of the arm bone. The scap- 
ula also contributes largely to the strength of the thorax and affords an 

extensive surface for the at- 
tachment of many of the 
powerful muscles of the up- 
per extremity. 

The clavicle, or " collar 
bone," so called from its re- 
is a long bone about six inches 
, and readilv felt under the skin. 




Fig. 13. — The collarbone. 



semblance to an ancient key, " clavis, 
in length, shaped like an italic letter 
Extending in a horizontal line from the sternum to the 
scapula, it acts as a prop to the shoulder, bracing it 
upward, outward, and backward. This function is 
very clearly seen in broken collar bone, when the 
shoulder falls downward, inward, and forward. An- 
other important function is the protection of the great 
vessels of the upper extremity as they pass out of the 
thorax into the arm, under the arch formed by the 
outer curve of the clavicle. Pressure between the first 
rib and the collar bone will discover the beating of 
the artery, and, in case of an injury to the arm, bleed- 
ing may be checked by pressing this vessel against 
the first rib behind the clavicle. 

The humerus or " arm bone " is a long bone with 
a head, a shaft, and a broadly flattened lower ex- 
tremity, extending from the shoulder to the elbow. 
The rounded head fits into the socket formed by the 
glenoid cavity of the shoulder blade. The shaft is 
cylindrical and light ; its junction with the head is 
called the surgical neck, on account of the frequency 
with which the bone is broken at this point. The 
lower end of the bone spreads out flatly to form a 
part of the hinge of the elbow. A projection on either 
side of the bone can readily be felt in every elbow ; 
these projections are the condyles, about which the 
strong muscles of the forearm are attached. On the 
anterior and posterior face, between the condyles, are 
depressions for receiving the projections of the ulna, 
the bone at the bottom of these cavities being ex- 
tremely thin. It should be observed that the shoulder 



Fig. 14. — The hu- 
merus or arm bone. 



BONES OF THE ARM AND FOREARM 



19 



joint is a ball and socket joint and almost universal in its movements, 
permitting the upper extremity to act in every direction. 

The portion of the upper extremity between the elbow and the wrist 
is called the forearm, and is formed by two parallel long bones, the 
ulna and the radius. The ulna is the larger bone of the forearm, and 
lies on the same side as the little finger. It receives its name from the 
Greek word meaning elbow, because of its participation in that joint. It 
does not enter into the wrist joint at all. The most peculiar feature of 
the ulna is the hook-like olecranon process at its head, in front of 
which the bone is hollowed out into the greater sigmoid cavity to receive 
the cylindrical lower end of the humerus into a 
hinge joint. This process is of the greatest impor- 
tance; it gives leverage to the great muscle which 
enables the pugilist to " strike out " ; it prevents the 
elbow from bending backward, and it protects the 
joint in leaning or striking on the elbow. From 
the front of the upper end of the ulna projects 
another but less important process, the coronoid 
process. The ulna terminates below in a blunt 
projection, the styloid process, the prominence of 
which can readily be felt and frequently seen in the 
living wrist. 

The radius receives its name from its resemblance 
to the spoke of a wheel. It is a long bone, on the 
same side of the wrist as the thumb, lighter than the 
ulna, and, unlike that bone, is broader at the lower 
end than at the upper. It enters but very slightly 
into the elbow joint, and alone of the forearm bones 
enters into the wrist. Both its ends rotate upon the 
ulna, — a provision which enables the hand to be 
turned palm upward or downward at will. The roll- 
ing of the radius upon the ulna, to turn the palm 
downward, is called pronation ; the reverse motion, 
turning the palm upward, is called supination. The 
lower end of the radius is broadened and hollowed 
out to receive the wrist bones; and on its inner face 
is a projection, called the styloid process of the 
radius, which can readily be felt in the living. The 
lower end of the radius is very frequently broken by 
persons falling upon the palms of the hands, or very violent pushing 
with the palms. 

It should be observed that the bones of the forearm do not lie in the 
same line as the arm bone, but that they form an obtuse angle with it. 
This provision makes it possible for the hand to be carried at some 
distance from the side, when the arm is held tightly against the ribs, 



VI 



H 



J 



Fig. 15. — The ulna 
and radius or 
forearm bones. 




20 CONSTRUCTION OF THE HUMAN MACHINE 

and gives to the upper extremity the " carrying function," enabling a 
person to carry a weight in his hand with the elbow braced against the 
side. 

The wrist is formed by the carpus, consisting of eight small bones, 
arranged in two horizontal rows, called respectively, counting from 
the thumb inward, scaphoid, semilunar, cuneiform, and pisiform, in the 
upper row, and trapezium, trapezoid, os magnum, and unciform in the 
lower row. The contiguous surfaces are encrusted 
with cartilage, and form regular joints. The division 
of the wrist into so many bones gives it strength and 
elasticity, together with a certain degree of motion, 
and it renders the liability of the wrist to be dislo- 
cated or broken vastly less than if it consisted of a 
single bone. 

The hand is composed of nineteen long bones, 

arranged end to end in five lines, corresponding to 

the five digits, the thumb presenting three bones, 

and each of the fingers four. The bones adjacent 

to the wrist are called metacarpal bones, and the 

Fig. 16. — The bones § tou P of nve metacarpal bones is called the meta- 

of the hand and carpus. The remaining bones are called phalanges, 

wrist. and numbered in each digit from the metacarpus to 

the tip, — first, second, and last or ungual phalanges. 

The spaces between the four metacarpal bones belonging to the fingers 

is filled, in the living person, with muscles and other organs, and the 

entire mass covered with skin, the front of it being the palm of the hand. 

The thumb is entirely independent from the beginning, and is peculiar 

not only in possessing but two phalanges, but also in having its action 

opposed to that of the fingers, which greatly facilitates the grasping of 

an object. For this reason the loss of the thumb disables the hand 

more than that of any of the fingers ; indeed, the loss of all of the three 

outer fingers would not affect the usefulness of the hand as much as 

that of the thumb alone. 

The hand is a piece of mechanism most wonderfully adapted to the 
thousands of purposes for which it is designed. Even the unevenness 
in the length of the fingers adds to its utility as well as its beauty. As 
an implement of labor, its uses are almost innumerable ; but it is also a 
most important feature of expression. In the words of Quintilian, it 
may express desire or willingness, it may bid one come or go, it may 
threaten or supplicate, it may display defiance or fear; joy or sadness, 
doubt or penitence, want or plenty, number or time, may all be shown 
by it. 

The pelvis is a great bony arch supporting the body and 
cransmitting its weight to the lower limbs ; it is a basin con- 



PELVIS AND* HIP BOXES 



21 




Fig. 17. — The pelvis or hip bones. 



taining and protecting a number of important viscera, whence 
the French call it " le bussing It is composed of four bones, 
the innominate or 
" hip bones," on either 
side, and the sacrum 
or " rump bone, ,v in 
the centre at the top, 
forming, as has al- 
ready been observed 
in connection with the 
spine, the keystone of 
the pelvic arch. At- 
tached to the lower 
end of the sacrum is 
the coccyx, which does 
not enter into the arch, but assists in the formation of the 
pelvic cavity. 

About the circumference of the pelvic cavity runs a line where the 
bone is thickened, and forms a projecting ridge ; this ridge is the brim 
of the pelvis. All that portion above the brim is called the false pelvis, 
and the portion below is called the true pelvis. The pelvis differs 
slightly in the two sexes. In order to facilitate childbirth in the female, 
the sacrum is wider and less curved, the cavity shallower and broader, 
and the pubic arch has a broader span. 

The pelvic arch is enormously powerful ; a wagon contain- 
ing over five tons has been known to pass over it without 
breaking the bones. The sacrum, shaped like the keystone 
of an arch and performing that function here, directly sup- 
ports the spine while the hip bones act as the pillars of the 
arch in continuation with the bones of the lower limbs. The 
bones of the pelvis afford extensive surfaces for the attach- 
ment of the. immensely powerful muscles of the trunk and 
lower limbs. 



The upper margin of the innominate or hip bones may readily be 
felt in the living person. In the direct line of the weight of the body on 
the outer convex surface of each hip bone, i,s a projecting cup with a 
hemispherical cavity called the acetabulum or vinegar cup. This is 
the socket into which the ball-like head of the thigh bone is set to form 



22 CONSTRUCTION OF THE HUMAN MACHINE 



the hip joint. The hip bones are formed by the fusion of three bones 
which are more or less distinct up to adult age, and which meet at 
the bottom of the acetabulum. The upper flaring portion, which 
may be felt at the hip, is the ilium ; this portion enters more exten- 
sively into the pelvic arch when standing. The thick heavy portion on 
the under and back part is called the ischium, and enters into the arch 
more particularly in the sitting posture, these bones forming the sup- 
ports of the body in that attitude. The lighter portion, with a large 
aperture, the obturator foramen, in its centre, and uniting with its 
fellow of the opposite side in front of the body, is called the pubes ; 
these portions of the innominate not only form the front of the pelvic 
cavity, but act as a tie-beam for the pelvic arch. 

The lower extremity includes the hip, 
already referred to ; the thigh, extending 
from the hip joint to the knee ; the leg, 
extending from the knee to the ankle ; 
and the foot, from the ankle to the tips 
of the toes. 

The femur or thigh bone is the longest and 
strongest in the body. Its length is a peculiarity 
of the human skeleton. The finger tips in man 
reach about to the middle of the thigh; in the 
most man-like of the monkeys they reach to 
the knee, and in others to the ankle, because of 
the shortness of the thigh bones. These bones 
do not stand perpendicularly. 

Like other long bones, the thigh bone presents 
two extremities and a shaft. The head is practi- 
cally a ball mounted upon a somewhat smaller 
neck ; this head is very firmly fixed in its socket, 
the acetabulum of the hip bone, and the motion 
of the joint is very free, so that the lower limbs 
suing like pendulums in walking, and the muscles 
need have but little to do either with keeping the 
bone in place or in moving the limb in walking. 
The head is mounted upon a portion of the shaft 
which is set somewhat at an angle with the rest, 
and is called the neck ; in infancy, this angle is 
quite obtuse, but it diminishes with age until in 
the old it may be even less than a right angle. 
This, in addition to the fact that its compact 
tissue becomes less and its cancellous tissue 




BONES OF THE THIGH AND LEG 23 

greater in amount, renders the neck of the femur much more liable to 
break in old persons than in the young. 

At the other end of the neck are two projections called the greater 
and lesser trochanters, to which the great hip muscles are attached. 
The great trochanter can readily be felt a few inches below the promi- 
nence of the hip. The shaft is very strong, and ridged and roughened 
in places for muscular attachments. The femur, like the humerus, 
widens as it approaches its lower extremity and presents a prominence 
on either side called the internal and external condyles. The two con- 
dyles are separated by an intercondyloid notch, dividing the end of the 
bone into two hemispherical portions which participate in the knee 
joint. 

In the tendon of the great muscular mass which straightens the knee, 
and directly in front of the knee joint, is found a 
triangular bone, the patella or " knee cap." It 
not only protects the joint, but increases the lev- 
erage of the muscles so as to add greatly to their 
power. It fits down into the intercondyloid notch 
when the knee is bent, but it lies quite free when 
the leg is straightened. When this bone is bro- 
ken, the power of straightening the leg is lost. 

The leg has two parallel long bones. The 

tibia or " shin " bone is vastly the larger, and 

1 x- 1 x -xi .1 ! • 1 1 1 1 F'g- 19. — The patella 

alone articulates with the thigh bone, and almost or j< nee cap< 

alone with the foot. Next to the femur it is the 

largest and strongest bone in the skeleton, and the two tibiae sustain 
the entire weight of the body. Both its upper and lower ends are 
widened, the upper more than the lower, while the shaft has the form 
of a prism. The top consists of two shallow cups separated by a slight 
elevation called the spine ; in these cups lie and move the condyles of 
the thigh bone. Just below this, in front, is a projection to which is 
attached the great muscle which straightens the leg. Its lower end is 
somewhat hollowed out to receive the upper extremity of the foot. Ex- 
tending downward and inward is a process which prevents the foot from 
being dislocated inward ; this makes a projection under the skin which 
is called the internal malleolus. The shin bone lies directly under the 
skin, in front, where its angle can readily be felt. 

Running parallel with the shin bone is the fibula, so called from a 
Latin word meaning clasp. In proportion to its length, it is the most 
slender of all the long bones. It does not sustain any of the weight of 
the body, nor does it enter into the knee joint. It is attached to the 
tibia just below and external to the knee, and passes down the leg to 
project as a process just below and external to the ankle. Firmly at- 
tached to the tibia at this point, it prevents the foot from being dislo- 
cated outward and forms the external malleolus, readily seen and felt 




24 CONSTRUCTION OF THE HUMAN MACHINE 



:'V'.«k 



:'" 



' 



under the skin. This bone is frequently broken about 
two and a half inches above the ankle by a sudden 
twist of the foot, the shin bone remaining unaffected. 
This injury is called " Pott's fracture." 

There are twenty-six bones in the foot, divided 
among the tarsus, the metatarsus, and the phalanges. 
The multiplication of bones produces an increased 
freedom of motion and greater elasticity, like the 
similar condition in the wrist. 

The tarsus, producing what the shoemakers call 
the " instep," is analogous to the carpus in the wrist. 
It is composed of seven tarsal bones, — the astraga- 
lus, which enters into the ankle joint, the calcaneum, 
the scaphoid, three cuneiform, and the cuboid 
bones. 

There are five metatarsal bones, numbered first, 
second, etc., from within outward ; unlike the meta- 
carpus, all five of the metatarsal bones are included 
within the same covering of skin, the interspaces 
being filled with muscles and 
other soft parts. Beyond the 
metatarsus are found the pha- 
langes of the foot, three in each 
toe, except in the great toe, 
which, like its analogue the 
thumb, has but two, and, like 
those of the fingers, they are 
called first, second, and ungual 
Fig. 20. —The tibia phalanges. The ungual pha- 
and fibula or leg lanx of the little toe is very 
bones. often fused with the second. 

In antique art the second toe 
is represented as longer than the first, but in the 
present age the great toe is found to be the larger 
in a great majority of cases. 

The foot forms two very important bony 
arches, one longitudinal, with the calcaneum be- 
hind and the heads of the metatarsus in front as 
its pillars, and the astragalus as its keystone ; the 
other arch is transverse, with its greatest con- 
vexity at the instep and its inner side thicker 
than the outer, while the cuboid and the cunei- 
form bones are so shaped as to unite in keying 

the arch. The absence of these arches consti- _. OI x , , _ , 

Fig. 21. — The bones of 
tutes flat foot. the foot 







THE HIXGES THE JOINTS 25 

In the bony framework of the body the arch, as a means of 
economizing material, is freely used. The skull is a dome 
of which the sphenoid bone is the keystone. The upper 
extremities and the chest form an arch, of less importance 
than some others, and yet not to be neglected. The ribs, 
the sternum, and the spine form a series of arches. The pel- 
vic arch has been described in detail, the lower extremities 
forming its columns. And those of the foot have just been 
noted. 



CHAPTER IV 
THE HINGES — THE JOINTS 



A joint is the juncture of two adjacent bones. Anatomists 
enumerate nineteen different kinds of joints in the human 
body. They may be (1) immovable, like the sutures be- 
tween the bones of the skull-cap ; (2) permitting but limited 
motion, like those between the vertebrae ; and (3) freely 
movable, as in the shoulder and other commonly recognized 
joints. 

• Of the movable joints, three are worthy of note: (1) The ball-and- 
socket joint, enabling the limb to be freely moved in all directions : this 
is the case with the shoulder joint, where the ball-like upper end of the 
arm bone fits into the glenoid cavity of the shoulder-blade; the spher- 
ical head of the thigh bone is" set in a similar way into the acetabulum 
of the hip bone. (2) The hinge joint, where the movement is limited 
practically to two directions, like a hinge : the knee and elbow joints 
are the most conspicuous examples of this. (3) The rotatory joint, 
where the end of one bone turns in a ring formed partly by the other 
bone and partly by a fibrous loop: this is seen in the joint between the 
upper ends of the two arm bones, the upper end of the radius revolving 
in a ring formed by a fibrous loop and a depression in the upper end of 
the ulna. 

The bones in a movable joint are retained in juxtaposition 
only to a small extent by the bony structure, and to a much 
greater degree bv ligaments and muscles. The character of 



26 CONSTRUCTION OF THE HUMAN MACHINE 



the ligaments, together with the shape of the adjoining por- 
tions of bone, determines the character of the joints. The 
parts of the bones participating in the joint are coated with a 
bluish white elastic substance known scientifically as carti- 
lage and popularly as " gristle "; sometimes, also, cartilage, 
strengthened by fibrous matter, is found at the edge of joint 
cavities, contributing to deepen them ; in some cases liga- 
ments lie within the joint cavity, and, covering all, is a 
capsule of fibrous tissue : the capsule also has a serous lining 
called the synovial membrane. 

Ligaments are masses of white fibrous tissue designed to 
unite separate bones. They may consist of bundles or cords 
extending from one bone to another, or they may take the 
form of capsules surrounding and covering the entire joint. 

The number of ligaments may 
vary from one, as seen in the 
joint between the upper ends of 
the bones of the forearm, to 
fifteen, as seen in the knee. 
While pliable and flexible so 
as to permit great freedom of 
motion, ligaments are strong, 
tough, and, with few exceptions, 
inelastic. They are attached to 
the bones by a mutual interlace- 
ment with the fibres of the 
periosteum. 

They are sometimes so powerful 
that the bone will be torn off before 
they are broken. A rupture of the 
ligament in front of the wrist joint is 
almost unknown, while the tearing 
off of the end of one of the bones of 
the forearm, the radius, by force ex- 
erted on the ligament, is one of the 
most common forms of broken bones. 
A similar condition is observable at the knee joint, where the " knee cap " 
is broken very much more frequently than the portions of the ligament 
attached to either end of it. In other joints the ligaments are corn- 




Fig. 22. — The shoulder joint, a ball- 
and-socket joint. Showing also 
ligaments connecting the collar 
bone with the shoulder blade. 



THE LIGAMENTS AND LINING OF THE JOINTS 2j 



paratively weak, in consequence of which some bones are much more 
frequently put out of joint than others. At the shoulder joint, where 
there is practically but one not very strong ligament, dislocations are 
very frequent, while at the knee, with its fifteen 
ligaments, that accident is almost unknown. 

A few ligaments consist of yellow elastic 
tissue. Such are the ligamenta subflava run- 
ning down the side of the spine. Such also 
is the ligamentum nuchse, extending from 
the vertebrae of the neck to the back of 
the head. The elasticity of this ligament is 
very important in the lower animals, whose 
neck habitually assumes a horizontal atti- 
tude ; for when the head is lowered, as in 
grazing, it may be elevated to its natural 
position by simply relaxing the muscles, and 
it is maintained in 
that position without 
weariness simply by 
the elasticity of this 
ligament. 

About the wrists 
and ankles the white 
fibrous tissue called 
the fascia, which lies 
underneath the skin 
throughout the body, 
is thickened to such 

an extent as to form a strong ligament-like 
ring. These rings are called the annular liga- 
ments of the wrists or ankles, and their func- 
tion is to hold the tendons of the muscles 
moving the hands and feet close to the 
bone, thus giving additional power to their 
action. 





Fig. 23. — The knee joint, a 

hinge joint, cut down 
the middle to show the 
relations of the bones 
and the ligaments. 



Fig. 24. — The joint be- 
tween the upper end 
of 1he forearm bones, a 
rotatory joint. The ra- 
dius has been removed 
to show the fibrous 
loop. 



The synovial membrane is a delicate 
membrane lining the capsules of joints 
and covering all ligaments that may be 
contained within joints, but not covering 
the cartilage. It secretes the synovia, 
or "joint oil," a yellowish or slightly 
reddish fluid, something like the white of an egg in feeling, 
which has for its function the lubrication of the joint. 



28 CONSTRUCTION OF THE HUMAN MACHINE 

In some joints the synovial membrane is thrown into folds which 
cross the joint and are known as synovial ligaments. Synovial mem- 
brane is also found lining certain bursae or pockets interposed between 
certain muscles and the bony surfaces over which they play, and certain 
sheaths, synovial sheaths, through which play the tendons of still 
other muscles ; in both these cases the secretion fulfils its function of 
lubrication. The synovial membrane is subject to inflammation in all 
these localities, producing an affection called " synovitis." 

Cartilage is a tough bluish or yellowish white elastic sub- 
stance, which, when found in meat on the table, is called 
" gristle. " It is tire precursor of bone ; even up to adult age 
some bones remain partly cartilaginous, while in the embryo 
the skeleton is almost altogether cartilage, the bones of the 
skull cap being the only exception. A child, then, has far 
more cartilage in his system than a man. In the adults it 
forms caps for the ends of the bones, and, by its elasticity, 
contributes to the diminution of shock and friction between 
them. It forms a large part of the walls of the windpipe and 
bronchial tubes, where it serves to maintain rigidity and pre- 
vent collapse ; it performs a similar function in the nose and 
ear, combining firmness and yielding. It supplies an elastic 
material in the costal cartilages, which form a part of the 
cage containing the breathing apparatus. 

There are no blood-vessels in cartilage, which reduces its liability to 
inflammation, to which its situation and its subjection to pressure would 
incline it otherwise. It imbibes its nourishment from adjacent tissues. 

The compressibility of cartilage, with which the ends of all bones are 
encrusted, makes possible another curious circumstance. Every per- 
son is taller upon arising in the morning than when retiring at night! 
This is due to the weight of the body in an erect posture acting upon 
the intervertebral and other cartilages so as to flatten them, their elas- 
ticity causing them to regain their original thickness at night, when, in 
the recumbent posture, all weight is removed. 

The value of this elastic substance between the bones, where it acts 
as a buffer, cannot be overestimated. Walking or jumping would be 
almost impossible were it not for this means of diminishing the jar 
which would be felt if the bones were directly in contact. 

Combined in the way described, the bones of the skeleton 
are joined together, every joint having a distinctive name. 



THE MOVING APPARATUS THE MUSCLES 29 

The shoulder, elbow, and wrist, the hip, knee, and ankle 
joints are familiar to every one. The knuckles, or metacarpo- 
phalangeal and the first and second interphalangeal joints in 
the fingers, are better known than the corresponding metatarso- 
phalangeal and interphalangeal joints of the foot and toes. 
The intercarpal and carpo-metacarpal joints of the wrist, and 
the intertarsal and tarso-metatarsal joints in the foot, are still 
less known. Joints between vertebrae and ribs, between the 
spine and the head, and between the head and the lower jaw, 
are all present and are considered by the anatomist. 



CHAPTER V 
THE MOVING APPARATUS — THE MUSCLES 

Having become acquainted with the bones and the joints 
which permit them to move in relation to one another, 
the question of the means of producing the movements 
naturally arises. The motive power of the body lies in the 
muscles. 

Muscles are "lean meat.*' Upon examination of the steak 
or roast, fibrous lines will be seen intersecting the meat in 
various directions, and, extending the examination to the beef 
before it is cut, these intersections will be seen to form sacks 
of considerable extent surrounding masses of meat of varying 
form and size, but alike in being attached at two extremities 
to bones. These masses are the individual muscles, and the 
fibrous intersections are sections of the weblike fibrous tissue, 
called fascia, which encloses not only each muscle, but certain 
masses of muscle and the entire body. 

The action of muscles is produced by the contraction and 
relaxation of their fibres shortening and lengthening the 
muscles, and thus bringing nearer together the two bones to 
which its ends are attached. This is well seen in the biceps 
muscle of the arm, one end of which is attached to the 



30 CONSTRUCTION OF THE HUMAN MACHINE 

shoulder and the other to one of the forearm bones. When 
the biceps is contracted, it draws the forearm and hand toward 
the shoulder, and w T hen it relaxes, it allows the arm to be 
thrown out straight. When a muscle contracts, it also grows 
thicker, as each person may see for himself by strongly draw- 
ing his forearm up toward the shoulder and feeling the thick- 
ness of the biceps muscle in front of his arm. The contrac- 
tile character of muscle is also shown by the wide separation 
of the lips of a cut into a muscle, the fibres on either side con- 
tracting and drawing them apart. 

The muscles act upon the bones, producing motion in various direc- 
tions ; these motions have received distinct names. When a limb is 
simply bent, as in bending the elbow or 
knee, the motion is called flexion, — the limb 
is flexed ; straightening the limb is called 
extension, — the limb is extended : the move- 
ments, pronation, turning the palm down- 
ward, and supination, turning it upward, have 
been described. Turning a limb about its 
long axis is called rotation. Abduction is 
throwing a limb outward, as when a leg is 
thrown to one side. Adduction, drawing 
a limb inward, is the reverse of abduction. 




Muscles produce all voluntary and 
some involuntary motion. If a man in 
walking catches his foot against an ob- 
struction and falls, the fall is involun- 
tary motion ; but when he throws his 
other foot forward to regain his equi- 
librium, that is involuntary motion. 
There are in the bodv both voluntary 

Fig. 25. — Voluntary mus- _ J J 

cuiar fibres, an. Large an d involuntary muscles. The volun- 
coiiections of fibrils, bb. tary muscles are those which are under 

Smaller collections of ^ CQntrol Q f the will like those Q f the 
fibrils, c. Still smallsrcol- . ... 

lections, d. The small- jaws, the arms, and the legs. The mvol- 

est that could be sepa- untary muscles are those over which 

rated * the will has no control, such as the 

heart and the muscles of the bowels. The word muscle, 

unmodified, is used in this book to signify voluntarv muscle. 



VOLUNTARY AND INVOLUNTARY MUSCLES 3 1 



Voluntary muscles are also called striated, and the involuntary nu- 
cleated, from their appearance under the microscope. The fibres of 
voluntary muscle consist of fasciculi about ¥ £o of an inch in diameter 
across which are seen regularly arranged transverse lines or striae, 
each fasciculus being enclosed in its own fibrous sheath or perimyseum. 
The fasciculi are united into a single bundle by means of a network 
of fine white connective tissue. The fasciculi are composed of a 
number of smaller fibrils about jshors of an inch in diameter, also en- 
closed in a transparent elastic sheath, the sarcolemma : each of these 
fibrils is composed of a series of discs or " sarcous elements " arranged 
end to end like a roll of coins. The contraction and extension of these 
discs produces the contraction and extension of the whole muscle. 

Involuntary muscles are composed of spindle-shaped cells, each with 
a clearly marked nucleus, but not striated. They are about 5^0 of an 
inch long by j-^jv of an inch broad, and are 
found in the muscular coats of the stomach, 
bowels, bladder, arteries, veins, and the heart 
and lungs. Involuntary muscles are not, then, 
attached to bones, and their contractions are 
irregular, one part contracting while a con- 
tiguous portion is relaxing, — a movement 
which may readily be seen in the intestines, 
where it is called the peristaltic motion. 

The advantage of the provision of 
involuntary muscles is evident ; for if it 
required an effort of will to cause their 
action, one might forget to breathe or to 
keep his heart beating, and die. But 
the involuntary muscle continues to 
act irrespective of the individual — the 
heart beats on, sleeping or waking, the 
stomach and bowels proceed with the 
act of digestion, and the lungs contract 
and expand in breathing regardless of the will of their owner 
or any surrounding circumstances. 

If the muscle which moves a limb be severed, the power of motion in 
the limb is lost. The voluntary are generally so arranged that the 
action of one group of muscles is counterbalanced by that of another. 
In the case, for instance, of a wound across the back of the hand divid- 
ing the muscles opening it, those closing it would have no opposition, 
and the hand would remain permanently closed; the reverse would be 
the case if the palm should receive such a wound. 



Fig. 26. — Involuntary mus- 
cular fibre, magnified 350 
times, a. Nucleus of the 
fibre. 



32 CONSTRUCTION OF THE HUMAN MACHINE 




It frequently occurs that these muscles of equilibrium are not at- 
tached to directly opposite portions of a bone; so that the bone 
may be broken between them and the broken 
ends of the bone drawn in opposite directions. 
This is shown in Fig. 27, where the thigh 
bone is broken between the psoas iliacus and 
the short head of the biceps cruris muscles, 
resulting in great displacement of the frag- 
ments. This action of muscles is of great im- 
portance in connection with broken bones, 
and will be referred to again in connection with 
that subject. 

A similar effect is produced when a bone 
has been thrown out of joint : the end which 
has escaped from its socket being held out of 
place by the tension of muscles, which must 
be relaxed before it can be returned. 

Muscles constitute the greater por- 
tion of the body, and to them it chiefly 
owes its contour. The calf of the leg, 
for instance, is composed entirely of 
muscles. The most beautiful figure, 
then, is the one in which the muscles 
are most uniformly and symmetrically 
developed, irregularities between them 
being filled in with fat. This function 
alone would require the existence of a 
large amount of muscular tissue, and, 
as a matter of fact, there are about 
four hundred and forty muscles in the 
human body, arranged in symmetrical pairs, one on each side 
of the body and forming about two-fifths of its weight. 

Muscles vary greatly in shape, some being cylindrical or 
spindle-shaped, others broad and thin, while still others are 
long and ribbon-shaped. Those of the arm and thigh are 
required to be the thickest in the body because of the heavy 
work required of them. The muscles of the abdomen and 
cheek on the contrary are broad and thin because they are 
designed to form walls to cavities. Muscles increase in size 
in proportion to their use. This fact is shown by comparison 



Fig. 27. — A fracture of the 
thigh bone, showing the 
action of the psoas ilia- 
cus muscle in pullingthe 
upper fragment out of 
place. A portion of the 
biceps is seen pulling the 
lower fragment in the 
opposite direction — the 
two muscles counter- 
balancing one another 
when the bone is whole. 



THE MOVING APPARATUS THE MUSCLES 33 

of the powerfully muscular athlete, who devotes himself to the 
exercise of his muscular system, with the thin, flabby man of 
sedentary occupation who neglects exercise. If a muscle be 
unused for a long time, it suffers not only diminution in size, 
"atrophy," but degeneration of its tissue, which is perma- 
nently fatal to its usefulness. 

Muscles begin at their attachment to one bone with reddish 
muscular tissue and end in inelastic glistening white fibrous 
tissue, forming the cord-like or strap-like tendons which are 
attached to the other bone and are commonly known as 
"sinews,' 1 "leaders," or "cords. 11 Where a muscle has a 
broad attachment, the tendon may be expanded into a strong 
fibrous sheet which is called an aponeurosis. Muscles may 
begin in several masses terminating in a single tendon as in the 
triceps, "three-headed, 11 or biceps, " two-headed, 11 muscles 
of the arms. Or they may begin as a single muscular mass 
and divide into a number of distinct tendons as in the fore- 
arm muscles which open and close the hand. Tendons are 
attached to bone by a mutual interlacement of their fibres 
with those of the periosteum. 

Within from seven to twenty-four hours after death, by 
reason of certain chemical changes, all muscles become rigid, 
producing what is known as rigor mortis, the stiffness of 
death, and the muscular tissue loses its contractility. The 
contractile power is a quality requiring the stimulus of vitality 
for its exercise, and although beginning decomposition relaxes 
the muscles again, it does not return. In persons suffering 
from great muscular exhaustion immediately prior to death, as 
in soldiers killed in a battle, rigor mortis sets in very quickly. 
In this way the attitudes and expressions of life are sometimes 
continued after death upon the battle-field. 

An important group of muscles is the muscles of expression in the face. 
As a rule, but one end of these muscles is attached to bone, the other 
being inserted into the skin. Joy and grief, pleasure and disappoint- 
ment, anger and satisfaction, are made evident in the countenance by 
the contraction and relaxation of these muscles. The occipito-frontalis 
is the muscle of the scalp, and produces the horizontal wrinkles in the 
forehead. The orbicularis palpebrarum and the orbicularis oris each 
aid in closing the eyes and mouth respectively, while the square masseter, 



34 CONSTRUCTION OF THE HUMAN MACHINI 




Fig. 28. -The Chief Superficial Muscles of the Human Body. 



THE MOVING APPARATUS THE MUSCLES 35 

aided by the temporal, contributes largely to the powerful closure of 
the jaws. 

Beginning just back of each ear and passing down the neck to the 
front of the breast bone are two muscles, one on each side, the sterno- 
cleido-mastoid muscles. They can readily be felt under the skin of the 
neck, and are for this reason of importance in marking the course of the 
great arteries of the neck, which run just in front of them. When 
one of them, through disease, becomes permanently contracted, the 
common affection " wry neck " is produced by the consequent drawing 
of the head to one side. 

On the chest lies the great fan-like chest muscle, the pectoralis major, 
extending from the chest to the arm bone and tending to draw the arm 
inward and forward. Just above this is the deltoid, a great triangular 
muscle attached to the shoulder and the arm bone and raising the arm 
to a right angle with the body. On the back the serratus magnus and 
a number of scapular muscles extend from the shoulder blade to the 
arm bone and draw the arm backward and inward. Another great 
muscle extends from the spine over to the arm bone and draws the arm 
downward and inward, or, if one hangs by the hands, it lifts the body 
upwards — this is the latissimus dorsi. 

In the arm, the biceps muscle extends down the front and bends the 
elbow, while the triceps extends down the back and straightens the arm. 
The biceps can be felt under the skin, and its inner border is a land- 
mark for the great artery of the arm. In the forearm are the muscles 
which move the wrist, hand, and fingers. In front and on the external 
side of the forearm are the extensor muscles which straighten the 
wrist, hand, and fingers. These tendons, beginning above the wrist, 
extend down the back of the hand, like cords, which can readily be felt 
under the skin. On the back and inner side of the forearm are the 
muscles which bend the hand, wrist, and fingers ; the flexor muscles, the 
tendons extending from the forearm to the hand. In the forearm are 
also pronator muscles which turn the palm downward, and supernators 
which turn it up. 

In the lower extremity are the glutei muscles, extending from the 
hip to thigh bone and drawing the thigh outward. Passing from the 
pubic bone to the thigh is a mass of adductor muscles which counter- 
balance the action of the glutei. In front is the great four-headed 
muscle, composed of the rectus femoris, the vastus externus and in- 
ternus, and the crureus, uniting into a single tendon in which the knee- 
cap is set, and acting together to straighten the knee. On the back are 
the biceps femoris and other hamstring muscles, which bend the knee, 
and whose tendons can readily be felt standing out under the skin, just 
above the back of the knee. The thigh muscles are the largest and 
most powerful in the body. 

In the leg are the muscles which move the foot, the tendons passing 



36 CONSTRUCTION OF THE HUMAN MACHINE 

over the ankle to their attachment in the foot or on the toes. The 
gastrocnemius and other great calf muscles unite into a single great 
tendon which is attached to the heel, and is called the tendo Achillis, 
or tendon of Achilles, since that hero is reputed to have been invul- 
nerable except at that point. The calf muscles enable one to rise on 
the toes; hence the exercise of rising on the toes produces growth in the 
size of the calf. The extensor muscles, on the front of the leg, turn the 
foot and toes upward, while the peioneus muscles, on the outside, turn 
the foot upward and outward. 

The interstices between the ribs are filled with muscles, while the 
entire abdomen is enclosed by the rectus abdominalis, the obliquus 
externus, and other abdominal and lumbar muscles, which form a 
muscular pocket for containing the stomach, bowels, and other ab- 
dominal viscera. Separating the chest from the abdomen is a muscular 
partition, the diaphragm or midriff, which assumes a dome-like' form, 
projecting into the chest and thus increasing the capacity of the abdo- 
men. The fibres of this muscle are attached to the circumference of 
the chest and converge to a tendinous centre. When these fibres con- 
tract, then they tighten the diaphragm and reduce the amount of pro- 
jection into the chest. This muscle performs an important function in 
connection with the act of breathing. 

It has already been remarked that those muscular organs which are 
not under the control of the will are composed of involuntary muscular 
tissue, and that these include the heart, bowels, bladder, stomach, lungs, 
arteries, and veins. 



CHAPTER VI 
THE CENTRAL POWER — THE BRAIN AND NERVES 

It has been stated in the preceding chapter that the muscles 
moving the body are subject to the control of the will. The 
question then logically follows, Where is the will located, and 
how are its wishes conveyed to the muscles? The will is 
located in the brain, and its volitions are carried to the 
muscles by the nerves. 

The nervous system, consisting of the brain and nerves, is 
much like a great railway system. The train despatcher sits 
in his office surrounded by ticking telegraph instruments, by 
which he is kept constantly informed of the movements of a 
large number of trains at varying distances, on a network of 



THE BRAIX AND NERVES 



37 



steel rails, at frequent points upon which are telegraph sta- 
tions, at which his messages, sent over the wires following 
the tracks everywhere, are delivered to the train officials. If 
it is necessary to detain a train, he quickly transmits a mes- 
sage to it and governs all its movements. When, on the 
contrary, the officials of a train are uncertain as to the course 
to take, they telegraph back over the same wires for orders. 
The office of the train despatcher is the brain of the rail- 
way, and he himself is the mind which controls and directs 
the workings of the trains, the muscles, through its nerves, 
the telegraph lines. Reversing the simile, the brain is the 
office of the train despatcher, that official is the mind which 
telegraphs its wishes over the nerves to the muscles, which 
move the body. 




Section of the brain down the middle line. 



The nervous system comprises the brain, the spinal cord, 
and the nerves. The brain is a large collection of gray cells 
and white fibres, situated in the dome-like cavity of the skull. 
It naturally divides itself into two parts, the cerebrum or 
brain, and the cerebellum or little brain. The former, which 



38 CONSTRUCTION OF THE HUMAN MACHINE 



appears like a gray mass of macaroni, lies in the upper and 
anterior part of the cranial cavity r and is by far the larger ; 
the latter is located in the posterior and lower part of the 
cranium, and its surface presents a succession of parallel 
horizontal ridges. The cerebrum is the site of the mind, the 
centre of all perceptions, and the seat of the intellect and the 
emotions. The cerebellum contributes the harmony of move- 
ments and the property of equilibrium. 

These organs are connected with the various portions of 
the body by means of innumerable white threads, called 

nerves — the telegraph 
lines with which the seat 
of the will is connected 
with the organs upon 
which it acts. From the 
under portion of the 
brain a great collection 
of nerves, crowded to- 
gether into a single great 
cord, passes down 
through the great aper- 
ture in the bottom of the 
skull into the canal in the 
spinal column — this is 
the spinal cord, or " spi- 
nal marrow. " It extends 
from the brain to the 
loins, a distance of about 
eighteen inches. 

At a point just before 
it passes out of the skull 
into the spine, the spinal cord swells out, forming an enlarge- 
ment called the medulla oblongata. The nerves of the face 
and head, and also those which influence the movements of 
the heart and lungs, come from the medulla oblongata. For 
this reason, wounds at this point are extremely grave, and 
death inevitably follows in a very short time. Breathing and 
the beating of the heart are stopped by the destruction of the 




Fig. 30. — The upper surface of the brain, show- 
ing the hemispheres, the great fissure, and 
the convolutions. 



THE CRANIAL AND SPINAL NERVES 



39 



nerve centres at which they originate. Small animals are 
often instantaneously killed for food by thrusting a needle into 
the medulla or by a quick blow just behind the ears, which 
wounds the delicate medullary substance. This is the prin- 
ciple upon which capital punishment by hanging is founded : 
the sudden drop should throw the spine out of joint with the 
skull and wound the medulla, producing instant death. 

A number of smaller collections of nerve fibres pass directly 
from the brain to the organs which they supply. These are 
the cranial nerves. It is worthy of note that the higher the 
function of an organ, the nearer the brain does it derive its 
nerve supply. This 
is evident from the 
important functions 
accorded to the 
cranial nerves, from 
which we derive 
smell, sight, hear- 
ing, and taste. 
There are twelve 
cranial nerves on 
each side, subdivid- 
ing into an immense 
number of branches. 

Out through the 
apertures between 
the vertebrae and 
on the sides of the 
spine, pass to the 
body the subdivi- 
sions of the spinal 
cord, the spinal 
nerves. There are 
thirty-one spinal 
nerves coming from each side of the spine, — sixty-two in all. 
These branch so as to reach all parts of the system and pro- 
vide every portion of the economy with a nerve centre, a 
telegraph station to the brain. 




Fig. 31. — The lower surface of the brain, showing the 
cerebrum, cerebellum, pons Varolii, and medulla 
oblongata, with the great fissures, the origins of all 
the cranial nerves and other organs. 



40 CONSTRUCTION OF THE HUMAN MACHINE 

There are two kinds of nerves, the motor nerves or nerves 
of motion, and the sensory nerves or nerves of feeling. The 
motor nerve conveys the impulse from the brain to the 
muscles which are to act. If a man wishes to grasp the hand 
of a friend, the desire is telegraphed instantaneously through 
the spinal cord and motor nerves to the muscles of the upper 
extremity, and the arm is extended and the hand clasped as 
desired. If he wishes to greet his friend, a similar impulse is 
telegraphed over the motor nerves of the face and throat, and 
the words of greeting are formed. Any other movement — 
winking, eating, walking, running, sitting, or standing — is 
influenced or produced in the same way. 

The sensory nerve, acting in a direction opposite to the 
motor nerve, conveys impressions or sensations from an 
organ to the brain. The man who has clasped the hand of -a 
friend knows that his friend has returned the greeting, because 
the sensory nerves in his hand perceive the pressure and flash 
the information to the brain through the spinal cord. The 
slightest touch is appreciated, and the brain informed of it 
with wonderful rapidity. The forms of the letters on this 
page make, upon the sensory nerves of sight, an impression 
which is conveyed to the brain, where the thought presented 
is appreciated. The alderman enjoys his terrapin, the florist 
is delighted by the odor of his flowers, the musician is 
charmed by sweet sounds, and the soldier feels the pain of 
his wounds, through sensory nerves passing from the tongue, 
the nostrils, the ears, and the injured part to the brain. 

Certain nerves contain both motor and sensory fibres, and an impulse 
and a perception going in opposite directions may pass through the 
same nerve at the same time. These are compound nerves. 

We know that this system of nerve telegraphy between the organs of 
the body exists, because when the line is cut by section of the nerve, 
the action or perception of the organ reached by it is lost. When the 
motor nerve fibres supplying a part are cut, the power of motion is lost 
in the part, — it is paralyzed, — and this is called motor paralysis. When 
the sensory fibres are divided, we have loss of sensation or sensory pa- 
ralysis. We more frequently see the two varieties of paralysis combined. 

The gray matter forming the outer coating and a few lumps in the 
centre of the brain, and the centre of the spinal cord, is composed of 



THE BRAIN AND THE NERVE CELLS 



41 



very minute cells of varying shape, most of them with one or more pro- 
cesses, some of which are directly continuous with nerve fibres. The 
white substance consists (Fig. 33) of a mass of fibres composed of a 
central fibre, the axis cylinder, about which is a coat of fatty matter 
called the white substance of Schwann, and, covering the whole, a deli- 
cate membrane, the neurilemma. 

The surface of the cerebrum (Figs. 30 and 31) is irregularly divided 
off into rounded prominences called convolutions, the deeper depres- 




Fig. 32. — Nerve cells, from the gray matter of the brain, showing the varying 
number of processes and the nuclei. 

sions between which are called fissures, while the more shallow are 
known as sulci. The cerebrum is divided by a deep fissure into two 
egg-shaped bodies called the right and left " hemisphere." The hemi- 
spheres are united at the bottom of the fissure by the corpus callosum, 
a mass of white fibres passing from one side to the other. The hemi- 
spheres are further subdivided, by other fissures, into " lobes." In each 
hemisphere is an irregular cavity called the right and left "ventricle" 
respectively, and into them project several masses of gray matter found 



42 CONSTRUCTION OF THE HUMAN MACHINE 



rilemma. 2. 

sheath, or white substance 

of Schwann. 3. Axis 

cylinder. 



in the interior of the brain, from some of which originate sight and 
smell. There are five ventricles in the brain. Upon the base of the 
brain (Fig. 31) are a number of projections and depressions which have 
received names, as well as the origins of the twelve cranial nerves. The 
pituitary body is a small reddish gray gan- 
glion, which is of interest because it was 
thought by the ancients to be the source of 
the nasal mucus, which was supposed to 
find its way thither in some way through the 
sphenoid bone. 

The gray matter of the brain seems to be the 
source of the intelligence, and the white sub- 
stance to be merely the carrier of impulses to 
Fig. 33. — Diagram of struc- or from it. The intelligence increases in pro- 
tureofnerve^fibre. I. Neu- por tion to the amount of gray matter, which 
dullary « s j ncreasec j j n proportion to the growth in 
the number of convolutions, by allowing it to 
dip down into the sulci, which afford a more * 
extensive surface for its accommodation. 
The comparatively few convolutions in children, and the still smaller num- 
ber in the lower animals, then, reduces their capacity for mental action. 
The pons Varolii (Fig. 31), bridge of Varolius, is a mass of nerve 
fibres passing from the spinal cord to the 
various parts of the brain and connecting 
them. 

In the medulla oblongata, many of the 
fibres of the spinal cord cross from one side 
to the other. It is due to this crossing or 
" decussation " that an injury to the right 
side of the brain causes paralysis of organs 
on the left side of the body, since a nerve 
starting from the right side of the brain 
passes down to the medulla oblongata, there 
crosses to the left side, and, passing down 
the left side of the spinal cord, emerges to 
the left side of the body. A nerve arising 
on the left side takes the opposite course. 

The brain of man weighs more than that 
of any of the lower animals except the ele- 
phant and the whale, that of the elephant turning the scales at eight or 
ten pounds, while the brain of a whale seventy-five feet long weighed 
only a little more than five pounds. The brain of a man weighs about 
three pounds, and that of a woman a few ounces less. The brain 
increases in weight with varying rapidity from infancy to between the 
thirtieth and fortieth year, after which it declines at the rate of about an 




Fig. 34. — Diagram of human 
brain, showing the course 
of the fibres and the situ- 
ation of the gray matter 
— the latter in black. 2, 
2, 2. Hemisphere. I, 3, 4, 
5, 7, 8. Central gray gan- 
glia. 6. Cerebellum. 



CRANIAL NERVES AND MEMBRANES 43 

ounce for each ten years. Contrary to the generally conceived opinion, 
the size of the brain does not appear to have any influence upon the 
power of the mind. 

The brain is enclosed in three membranes : (1) Immediately next 
to the brain is the pia mater, consisting of a minute network of blood- 
vessels held together by fine connective tissue ; it dips down into all the 
sulci and fissures. (2) The arachnoid or spider-web-like, a delicate 
membrane which does not dip into the grooves. (3) Outside of this is 
the dura mater, a dense fibrous membrane, which forms a strong and 
inextensible sac for the brain. Between the arachnoid and the pia 
mater is found a fluid, the cerebro-spinal fluid, affording a water 
cushion to lessen the effects of jar upon the brain. 

The substance of the brain is exceedingly tender, and easily crushed. 
For this reason it is protected not only by a strong, dense membrane, 
but also by a case of bone — the skull-cap — which prevents contact 
with injurious violence. Pressure of any kind, even the most gentle, 
interferes with the action of the brain. When the skull is broken and 
the fragments press in upon the brain, paralysis in some part of the 
body, or loss of consciousness, or both, invariably appears. Even so 
gentle a pressure as that exerted by blood leaking from a small vessel 
is sufficient to cause insensibility, paralysis, and often death; for it is 
apoplexy. 

Continuous with the brain are the twelve pairs of cranial nerves and 
the spinal cord. (1) The olfactory nerve contributes the sense of 
smell. (2) The optic nerve conveys the sense of sight. (3) The 
motor oculi influences the movements of the eye. (4) The patheticus 
controls the act of rolling the eye upward. (5) The trifacial gives 
feeling to the eye, face, and mouth, influences chewing, and helps to fur- 
nish the sense of taste. (6) The abducens makes it possible to turn 
the eye to the side. (7) The facial supplies the expression of the 
features. (8) The auditory imparts the power of hearing. (9) The 
glosso-pharyngeal contributes feeling to the throat and helps the sense 
of taste. (10) The pneumogastric gives feeling to the throat and con- 
trols the muscles of talking, breathing, and the beating of the heart, 
(n) The spinal accessory supplies motion to certain muscles of the 
neck. (12) The hypoglossal imparts the power of motion to the 
tongue. 

The spinal cord is a long, rod-like mass of white nerve fibres sur- 
rounding a central mass of gray matter. The fibres communicate 
with the gray matter of the brain. The front of the spinal cord gives 
origin to motor nerve fibres, and the back of the cord gives origin to 
sensory fibres. When a man is struck, he feels it with the back of the 
spinal cord, but the front of the cord causes him to move forward, to 
seek safety. The front of the cord then may be diseased so that impulses 
can no longer be conveyed through it, while the back maybe unaffected, 



44 CONSTRUCTION OF THE HUMAN MACHINE 




Fig. 35. — Diagram of the nervous system, showing the superficial nerves on the 
right, and the deep nerves on the left side of the body. I. The cerebrum. 
2. The cerebellum. 3, 3. The spinal cord. 4. The sciatic nerve. 



THE SPINAL CORD AND THE NERVES 45 

in which case the sick person would be unable to move his limb, while 
at the same time he could feel every touch upon it. In the same way 
feeling may be paralyzed, while motion is not affected. 

The gray cells themselves of the spinal cord have the power of orig- 
inating certain unimportant acts. If the hand be accidentally brought 
in contact with a hot stove, it is often drawn back by a rapid convulsive 
motion before the pain is felt or the reason of the act is realized. In 
the same manner, if one loses his balance, he throws his hands out to 
regain it automatically, not realizing the act until it is all over. The 
rapid movements of the fingers of the piano-player become unconscious 
and automatic. These acts are unintentional and even unconscious — 
and dependent upon no volition of the brain. They originate in the 
gray cells of the spinal, cord, and this is called the reflex action of the 
sp'mal cord. 

From the sides of the spinal cord pass the nerves to the various parts 
of the body. Through the interstices between the cervical vertebrae 
passes, among others, the phrenic nerve, which passes down to the dia- 
phragm or midriff, and is an important factor in breathing, and the 
brachial plexus which supplies the upper limb. This plexus gives off 
nerves to the skin and muscles of the arm, the median and ulnar to the 
front of the forearm, and the musculo-spiral and radial to the back of 
the forearm. Between the dorsal vertebrae emerge nerves to the chest 
and back. Between the lumbar vertebrae pass out the nerves forming 
the lumbar plexus, branches of which go to the front of the lower limb. 
And between the sacral vertebrae pass out the nerves which, together 
with the lower lumbar, form the great sciatic nerve, which runs down 
the back of the thigh and supplies the back of the lower extremity. 

A knowledge of the points from which the nerves arise is a help to the 
diagnosis of the points at which the cord is injured in case of spinal 
injury. If the back of the lower limb, for example, is paralyzed and the 
front is not affected, we know that the lesion lies between the lumbar 
and sacral vertebrae. The origin of the various nerves being known 
minutely, the location of an injury may be very definitely located in this 
way in any part of the cord. 

The Sympathetic System. — In connection with the involuntary 
muscles, we have referred to the necessity for a system which should be 
free from the control of the will. The involuntary muscles receive their 
nerve supply, not from the great cerebro-spinal system, which has been 
described, but from a special system, called the sympathetic system, 
and consisting of a double set of small collections of gray matter called 
ganglia, lying along the sides of the spinal column. These ganglia are 
mutually interconnected, and send off nerves which form plexuses, and 
go directly to special organs. It controls the heart and blood-vessels — 
a fortunate circumstance ; for were they under the control of the volun- 
tary nerves, the heart would stop when one goes to sleep. It supplies 



46 CONSTRUCTION OF THE HUMAN MACHINE 

and controls the involuntary muscles and organs of secretion and excre- 
tion. Were it not for this system, digestion would cease and breathing 
would be suspended. Perhaps the action of the sympathetic system 
may be seen most clearly in the pupil of the eye, which, without any 
aid from the will, invariably adapts itself to the circumstances under 
which it is placed : if it be dark, it dilates in order to let as much light 
as possible into the eye ; if, on the contrary, the light be brilliant, it 
contracts to a mere pin point, to avoid flooding the eye with light. 

While, as in the beating of the heart and the breathing, in most 
instances the sympathetic system acts continuously, in some others it 
requires some irritation to produce its action. The iris, with its changes 
subject to the variations of the light, is an excellent example. The con- 
tact of food with the'interior of the stomach, which causes that organ to 
begin the churning motion needed for digestion, is another. 

Mental emotions may also have a reflex action upon the sympathetic. 
Terror dilates the pupil, and bashfulness acts upon the nerves of the 
small blood-vessels of the face so as to produce blushing. 

Irritation of the sympathetic nerves may in its turn have a reflex 
action upon the cerebro-spinal system. The convulsions of children 
are often due to the presence in the bowels of undigested food. The 
same cause has been known to make a child cross-eyed and even 
partially paralyzed 



CHAPTER VII 

THE REPAIR APPARATUS — THE BLOOD AND ITS 
CIRCULATION 

The human machine, like artificial machines, is affected 
by constant use with wearing and breakage. When the 
machinery of a clock becomes worn or broken, it is neces- 
sary to take it to a clock-maker and have it repaired by replac- 
ing the disabled part with a new one, or joining together the 
fragments. The human machinery, however, contains in 
itself the means of overcoming the effects of wear and tear — 
it is self-repairing. By this provision waste is remedied, 
growth is produced, and good working order is maintained. 

This combined function, common to all animal bodies, 
is called nourishment. The nourishment of the body is pro- 
vided by the blood. In addition, the blood acts as a scaven- 
ger in carrying off the waste products, a contribution to the 




THE BLOOD 47 

process of excretion which will be studied in a separate 
chapter. 

The blood forms from one-twelfth to one-eighth of the 
weight of the body and is estimated at about a gallon and 
a half in bulk. Its presence is necessary to the continu- 
ance of life, death rapidly ensuing 
after great losses. The blood is 
a bright red color in one set of 
blood-vessels — the arteries — and 
dark red or purple in another — 
the veins. This color is due to the 
presence of microscopic red blood- 
corpuscles, which, when viewed 
singly, under a high magnifying 
power, are light yellow in color, r . 0< - u ... 

fe J ' Fig. 36. — Human blood-corpus- 

but when aggregated together in c ies. a. Red corpuscles seen 
vast numbers produce the familiar flatwise ; b. Seen edgewise ; 

Crimson hue. C ' White corpuscle. 

The blood is composed of red and white corpuscles floating 
in a liquid called the liquor sanguinis. The red corpuscle 
is a circular disc about 3 2V0 °f an mcn m diameter, and fifty 
million of them may be collected into a cubic line. Their 
number, however, is so enormous that it has been estimated 
that if all the red blood-corpuscles in the blood of a single 
individual were placed end to end in a single row, they would 
form a continuous line long enough to encircle the globe four 
times. They are hollowed out on both faces into a bicon- 
cave shape. They are soft and elastic in structure, readily 
resuming their form after the removal of pressure which has 
distorted them. 

Next to water, which forms a little more than half of these bodies, 
their principal constituent is haemoglobin, a compound containing iron, 
to which is due the red color of the corpuscles. Haemoglobin unites 
readily with oxygen, and contributes the oxygen-carrying function to 
these corpuscles. 

White blood-corpuscles or leukocytes are also present in 
the blood, in the proportion, in health, of but one to five 
hundred of the red. They are shaped much like a sphere, 



48 CONSTRUCTION OF THE HUMAN MACHINE 



are granular in appearance, and about 2T00 of an mcn in 
diameter. 

They are peculiar in the ability to exhibit spontaneous changes of 
shape Tike the amoeba, an infusorial animalcule of the lowest grade of 
life. These movements are thence called amoeboid, and consist in the 
protrusion of processes of the jelly-like mass composing the corpuscle, 
which may be drawn back and other processes protruded. By the 
exercise of this function, the white corpuscles under certain circum- 
stances are enabled to penetrate through the walls of blood-vessels into 
the neighboring tissues. The corpuscle first throws out a slender proc- 
ess which it insinuates through the vessel wall and then draws the rest 
of its body through the opening thus made. In any severe inflam- 
mation the white corpuscles crowd to 
the inflamed part and, unless the 
inflammation is subdued very early, 
they congregate in the tissues and 
form the yellow "matter" — pus — 
found in abscesses or boils. 




Fig. 37. — Large frog's capillary, show- 
ing white corpuscles pushing 
through the walls by means of 
amoeboid motion. a, a, a, a, 
Cells in the act of passingthrough. 
The red corpuscles of the frog are 
oval, as seen in the figure. 



The liquor sanguinis is a 

clear, slightly thickened yellow- 
ish fluid in which the corpuscles 
float. It consists of serum and 
the elements of fibrin. Fibrin 
is an albuminous substance 
which remains in solution when 
the blood is in motion in the 
body, but when the flow of blood 
is stopped for any reason in the 
vessels, or when it has been lost 
from the body, it appears as a network of fine fibrils which 
entangles the corpuscles in its meshes and forms a jelly-like 
mass called a blood-clot. 

This process is coagulation, or clotting of the blood, and 
a clot may be formed in a few minutes. It first includes 
the serum in its substance, but this gradually separates, the 
clot contracting in size, until the two are entirely separate. 
The function of fibrin as a producer of clotting is of very great 
importance : if clotting did not occur, a very small cut might 
cause bleeding sufficient to empty the body and cause death ; 
but in moderate cuts the clot forms quickly and ? closing the 



THE FUNCTIONS OF THE BLOOD 49 

bleeding vessels, stops the bleeding. Moreover, the material 
which is produced for the permanent healing of the injured 
part contains a principle identical with fibrin, which thus 
exercises important healing functions. 

The serum is liquor sanguinis from which the fibrin has been removed. 
It contains albumen, a substance similar to the white of an egg, fatty 
matters, carbonic acid, oxygen and nitrogen gases, and salts. The salts 
of the blood must not be confused with the salt used for seasoning food 
or with the " salts " used in medicine as a cathartic : they are substances 
formed by the union of a base, such as iron or lime, with an acid. 
Some of these salts enter into the formation of tissues, especially of 
bone, others are decomposed and recombined in the body, and still 
others are on their way to be thrown off as waste products. Certain of 
them also increase the absorptive power of the serum for gases. While 
the fatty matters are partly the means by which the supply of fat in the 
body is maintained, they also are the main source of the secretions of 
milk and bile, and, by their union with oxygen, assist in maintaining the 
warmth of the body. Of the gases, the oxygen is a nutritive on its way 
to be absorbed, and the carbonic acid is a waste product on its way to 
be cast off. The albumen goes to'the nourishment of the tissues, which 
consist largely of modifications of it. 

When, as the result of certain diseases, the serum passes out of the 
blood-vessels, the condition is called dropsy. When it is distributed 
through the tissues, giving them a puffed, swollen appearance, and the 
depression made by pressing the finger into the swelling is not promptly 
effaced, the condition is called oedema. When the serum collects 
in cavities, it receives still other names. Dropsy of the chest occurs in 
pleurisy, and ascites, or dropsy of the abdomen, is comparatively 
common. 

An important function of the blood is to maintain and 
equalize the heat of the body, as well as to provide it with 
the requisite moisture for the performance of the various 
functions of life . 

Its function as the source of the materials needed for the 
nourishment of the system has been noted. It is a vehicle 
for the reception and storage of nutriment — food, drink, and 
oxygen — and for its conveyance to the tissues. 

*It absorbs refuse matters from the tissues and conveys them 
to the organs provided for separating them and removing 
them from the body. This process is more fully discussed in 
connection with the apparatus for the disposal of waste. 



50 CONSTRUCTION OF THE HUMAN MACHINE 

The vehicle for the conveyance of food to and the carriage 
of waste from the tissues, being the blood, we naturally look 
for the force which moves the vehicle and the roads over 
which it travels. The blood is kept in perpetual movement 
through the body by a great stationary engine, the heart, 
over innumerable roads called blood-vessels. 

The heart is a hollow conical involuntary muscle, rather 
larger than a man's closed fist — about rive inches long and 
between three and four inches wide, weighing about nine 
ounces in woman, and eleven in man. It lies in the chest, 
behind the breast bone, rather more upon the left side, with 





Fig. 38. — Human heart, front view. Fig. 39. — Human heart, back view. 

a. Right ventricle, b. Left ventricle. a. Right ventricle. /;. Left ven- 

c. Right auricle. d. Left auricle. tricle. c. Right auricle. d. Left 

e. Pulmonary artery, f. Aorta. auricle. 



its larger end, or base, above, and its point, or apex, point- 
ing downward and to the left. It rests upon the midriff below, 
and its apex during life beats against the chest wall in the 
space between the fifth and sixth intercostal cartilages, 
about two inches below the left nipple, and an inch and a half 
to the left of the middle line of the body. At this point the 
beating of the heart can readily be felt, heard, and often seen 
moving the chest wall as it strikes against it. 

The heart, practically consisting of two conical muscles 
laid side by side, is usually considered as divided by a par- 
tition into two divisions which have no communication with 
one another. Each of these divisions contains two cavities, 
separated from one another by a horizontal muscular wall 
containing a communicating aperture. The upper cavities 
are called auricles, right and left, and the lower are known as 



THE HEART 



51 



ventricles, right and left, and the openings between them are 
the auriculo-ventricular openings, right and left. 

The walls of the auricles are thin and rather membranous, while 
those of the ventricles are thicker and muscular. The walls of the left 
ventricle are the thicker, and the muscle the more powerful because of 
the greater amount of work it has to do. Each of these chambers con- 
tains other openings, where the great vessels communicate with them. 
These apertures are all provided with valves which permit the blood 
passing through them to go in but one direction. The valve on the 
right side, which permits 
blood to pass from the right 
auricle to the right ventricle, 
but prevents its return, 
is called the " tricuspid " 
valve, because it consists 
of three little membranous 
flaps which fall over the 
opening and close it, being 
kept from falling through to 
the other side by a number of 
fine cords attached to them. 
The valve on the right side 
is called the " mitral " valve, 
from its supposed likeness 
to a bishop's mitre, and con- 
sists of two flaps which close 
together in the same manner 
as those of the tricuspid 
valve. 

The other apertures in the 
heart are the openings of the 
great blood -vessels, the veins, 
into the auricles, and the 
arteries into the ventricles. 
Valves are situated at these openings also, those in the auricles prevent- 
ing the return of the blood into the veins, and those in the ventricles 
preventing the return from the arteries. The vessels all enter the heart 
at its base, — the upper extremity, — and the heart is suspended from the 
chest walls by them. 

The heart is enclosed in a bell-like membranous sac, the pericardium, 
the lower end of which, in order to give room for the play of the apex of 
the heart, spreads out on the midriff, while the upper end is lost 
upon the great blood-vessels. This sac is lined with a serous membrane, 
which is also continued over the surface of the heart itself: serous sur- 




Fig. 40. — The heart, in relation to the chest 
walls and the lungs, the flap of the latter 
which partly covers it in front, having been 
removed, vi. Innominate vein. ao. Aorta. 
v. c. Superior vena cava. r. an. Right 
auricle. /. an. Left auricle, r. v. Right 
ventricle. /. v. Left ventricle. 



52 CONSTRUCTION OF THE HUMAN MACHINE 

faces are characterized by extreme smoothness, which is increased by 
the secretion of a lubricating fluid. This, then, makes it possible for 
the surfaces of the heart and pericardium to glide upon one another 
with the least possible amount of friction. 

The blood-vessels are closed pipes or tubes through which 
the fluid blood is propelled throughout the body. They are 
of three kinds, — the arteries, the capillaries, and the veins. 

The arteries are fibro-muscular tubes through which the 
blood is carried from the heart to the various portions of the 
body. They permanently retain the shape of a hollow cylin- 
der, even when empty. They are open from end to end, 
presenting no valves to limit the flow of blood in them. 
Consequently, if one of them be cut, the blood will continue 
to flow from the wound until there is none left in the body, 
and death will follow unless it be closed. 

They contain a large amount of elastic tissue in their walls, which pre- 
vents shock from the sudden influx of blood following a heart-beat, 
maintains an equal pressure during the interval between the heart-beats, 
enables the vessels to adapt themselves to any increase or diminution 
in the amount of blood, and also to different movements of the body. 
The muscular elements of the arteries regulate the amount of blood to 
be received by each part or organ at any given time in accordance with 
their needs ; and when an artery is cut, the muscular elements diminish 
the size of the opening, in some cases even closing it, and help to check 
the bleeding. 

Two great arteries start from the ventricles, the pulmonary 
artery from the right, and the aorta from the left. These 
break up by continual dividing into a great number of 
branches, constantly diminishing in size. The smallest 
arteries are sometimes called arterioles. 

The smaller arteries freely communicate with one another by branches 
extending from one to another, thus constituting an arterial network. 
This communication is called anastomosis. It is a wise provision to 
obviate the cutting off of the blood supply and producing the death and 
decay of a part by the closure of the artery supplying it. The intercom- 
munications of the arteries are especially extensive about the joints, the 
upper extremity, and the head. In consequence of this anastomosis, 
when an artery is cut, the blood flows not only from the end toward the 
heart, but when that is closed by any means, the blood passes around 
through an anastomosis and spurts out through the farther end of the 



THE BLOOD-VESSELS 



S3 



vessel. This route for the blood around an accidental closure is called 
the collateral circulation, and where it exists freely it makes it neces- 
sary to close both ends of a divided artery. 

The capillaries are the smallest of the blood-vessels, and 
may be considered either as the terminations of the arteries 
or the beginnings of the veins, for it is impossible to ascertain 
the exact point at which the venules begin or the arterioles 
end. They form an immense network, furnishing the blood 
supply of the entire system, and are characterized by main- 
taining the same diameter from end to end, unlike other 
vessels, which diminish in size in one direction. They are 
about 3 q\ o of an inch in diameter, and 
are composed of two very delicate 
membranes, which do not interfere 
with the passage of the constituents of 
the blood through them into the tissues, 
or from the tissues into the blood. It 
is in these vessels that the final aim of 
the circulation is accomplished. Here 
is extracted from the blood the nutrition 
brought into the circulation by the 
arteries, and here the blood acquires 
the waste products which are to be 
carried away by the veins. 

The veins are formed by the union 
of two or more capillaries, and contin- 
ually joining together, ultimately form 
large trunks, just as the little brooks and streamlets join to 
form larger streams, and, by continually uniting, at last 
form the mighty river flowing down to the sea. Finally the 
veins unite into two great venous trunks, — the inferior vena 
cava, bringing the blood from the body and lower extremities, 
and the superior vena cava, bringing the blood from the head 
and the upper extremities into the right auricle. The pulmo- 
nary veins, four in number, bring the blood from the lungs to 
the left auricle. 

Unlike the arteries, the veins collapse when empty, and 
enlarge when filled. This can readily be seen in the veins 




Fig. 41. — Capillary network 
from the bowel, showing 
how the capillaries con- 
nectthe veins and arteries. 



54 CONSTRUCTION OF THE HUMAN MACHINE 




in the hand and forearm, which are ordinarily small and 
inconspicuous, but after any exercise which tends to increase 
the flow of venous blood, or when the arm is tightly bound 
so as to delay the flow of blood toward the shoulder, the 
vessels become large and prominent. 

Unlike the arteries, the flow of blood in which is caused by the pump- 
ing of the heart, the veins have no organ which directly forces their 
contents to their destination. The movement of blood through the 
. veins is due to four causes. (i) The 
pressure behind of the blood pushed into 
the capillaries from the arteries by the 
heart; this is the main cause. (2) The 
presence of valves at frequent intervals, 
which prevent the backward flow of blood. 
This provision in veins is of great surgical 
importance, for the blood can only flow 
from the smaller end of the vein, which 
greatly diminishes the danger of bleeding 
in such injuries. (3) The pressure of 
muscles upon the veins presses out the 
blood from the veins underneath them, 
and, as the valves prevent its retreat, it 
must go forward. (4) The suction on the 
The blood is passing off in large veins, when, in breathing, the air is 
this case by a lateral channel, drawn into the lungs, also assists slightly 
as indicated by the arrow. m the movemen t of the blood. 

The blood has two distinct courses, called the pulmonic or 
lung circulation, and the systemic circulation. In the lungs 
the blood is purified, and in the system it is polluted. 

Such are the various portions of the machinery by which 
the blood is forced through the body. The blood-vessels are 
simply pipes through which the blood is forced by a pump. 
The pump is the heart, and its mechanism is very simple. 
The blood having passed through the auricle into the ventricle, 
the muscular fibres contract and the walls of the cavity are 
brought together ; the backward pressure closes the valve at 
the auriculo-ventricular opening, leaving in each side of the 
heart but one means of exit — the opening into the aorta in 
the left ventricle, and that into the pulmonary artery in the 
right; the blood is consequently forced into these vessels. 



Fig. 42. — Diagram showing a 
vein with the valves ciosed. 



THE CIRCULATION OF THE BLOOD 



55 



As the ventricle contracts, the 
corresponding auricle relaxes 
and is filled with blood. The 
contents of the ventricle having 
been expelled, it relaxes while 
the auricle contracts, filling it 
again. This contraction and 
relaxation of the heart muscle 
produces the heart-beat ; it oc- 
curs in the adult about seventy- 
five times a minute. 

The circulation of the blood 
is well shown in the accom- 
panying diagram. Starting in 
the (i) lungs, where after its 
excess of carbonic acid has been 
cast off and its supply of oxy- 
gen has been taken on, giving 
the blood a bright red color, 
(2) it passes through the pul- 
monary veins into (3) the left 
auricle ; thence through the left 
auriculo-ventricular opening 
into (4) the left ventricle, 
where, by the contraction of 
the ventricular walls, it is sent 
through the aortic opening into 
(5) the arteries. From the 
arteries it floods the entire body 



Fig. 43. — Diagram of the circulation. 
I. The lungs. 2. The pulmonary veins. 
3. The left auricle. 4. The left ven- 
tricle. 5. The arteries. 6. The capil- 
laries. 7. The veins. 8. The right 
auricle. 9. The right ventricle. 10. The 
pulmonary artery. II. The capillaries of 
the liver. 12. The capillaries of the 
spleen. 13. The capillaries of the ali- 
mentary canal. 14. The kidneys. 




$6 CONSTRUCTION OF THE HUMAN MACHINE 

by means of the great network of (6) capillaries. In the capil- 
laries, the blood discharges its load of oxygen and other nu- 
tritious substances into the body, and takes on a load of waste 
carbonic acid which changes its hue to a purplish tinge. The 
blood, now darkened by impurities, passes on from the capil- 
laries into (7) the veins, and thence, by a separate vein for 
the upper and lower extremities, into (8) the right auricle of 
the heart, and on into (9) the right ventricle, whence it is 
thrown through (10) the pulmonary artery back into (1) the 
lungs. 

In the diagram are indicated also (11) the capillaries of the liver, (12) 
those of the spleen, and (13) those of the alimentary canal, which unite 
together to form the " portal circulation " so called, because all the blood 
is delivered into the vena cava through the portal vein in the abdomen. 
A portion of the blood also passes through (14) the kidneys, where is 
performed a most important excretory function which will be considered 
in connection with the apparatus for the disposal of waste. 

It takes about half a minute for the blood to pass through 
this entire course. During this period all the blood in the 
body makes the circuit of the system. 

The pulse is caused by the wave produced by throwing a mass of 
blood into the arteries already containing that fluid. It is the same 
effect as is produced by suddenly throwing a bucket of water into a 
quiet pool. Waves are made to travel in all directions. The blood 
wave, as it travels through the vessels, striking upon the elastic wall of 
the arteries, causes a temporary dilatation which is followed by imme- 
diate contraction — this is the pulse. The pulse can be felt in any 
artery, but for the sake of convenience, it is usually felt in the radial 
artery on the outer side of the palmar face of the wrist. The pulse 
wave could not be caused by the progress of the new blood thrown 
out from the heart, for the wave travels much faster than the blood 
itself; in any case, however, the difference is not more than a fraction 
of a second. 

The pulse beat agrees in frequency with that of the heart which causes 
it. In adult life, the average number of pulsations in a minute is 75. 
In infancy it runs between 120 and 100, and in old age between 70 and 
60, although in extreme old age, " second childhood," it again becomes 
more rapid, running between 75 and 80. The pulse of woman is usu- 
ally more frequent than that of man, and it is more rapid when standing 
than when lying down, quicker when exercising than when quiet, and 






THE ARTERIES AND VEINS 57 

slower in rest or in the interval between meals than when exercising 
mentally or physically or during digestion. 

The pulse is an invaluable adjunct to the diagnosis of disease. 
Fever is invariably characterized by increased frequency of the pulse, 
the amount of quickening varying according to the variety of fever. 
Inflammation causes rapidity of the pulse with a hard, tense feeling 
added. In extreme weakness, as just before death, the- pulse is very 
rapid and very small, so that it is called "thready." A pulse of 160 in 
an adult is an almost positive sign of impending death. The pulse may 
be normally slow in certain individuals, and an abnormally slow pulse 
is present in pressure on the brain and in opium poisoning. The pulse 
may be irregular in its beat or even intermittent. Still finer distinctions 
with regard to the character of the pulse are made, each one of which 
have their value in the diagnosis of disease. 

Differences between Arteries and Veins. — Before pro- 
ceeding to a consideration of the individual arteries and 
veins, we may with advantage briefly recite the differences 
between the two varieties of vessels : (i) Arteries are stiff 
tubes, having strong elastic walls and remaining open when 
emptv : veins, on the contrary, are thin and flaccid, and their 
walls collapse after their contents have flowed out. (2) Ar- 
teries present no obstruction throughout their entire length ; 
veins present frequent valves to prevent the backward flow of 
blood. (3) Arteries present a rapid flow of blood with a 
remittent pulsation dependent upon the heart beat : veins 
present a slow and steady current. (4) Many veins lie close 
to the surface, and where veins and arteries run together the 
vein is almost invariably the more superficial ; the arteries lie 
more deeply. (5) Arteries carry blood from the heart ; veins 
bear it toward the heart. (6) Arteries are filled with bright 
red blood, purified by oxygen for the nutrition of the system ; 
veins bear a current of dark purplish blood, polluted with 
carbonic acid and other waste matters. This condition is 
reversed in the case of the pulmonary artery and vein. 

The Arteries. — The aorta is the greatest artery in the body. Start- 
ing from the left ventricle of the heart, by an orifice closed with semi- 
lunar valves to prevent the blood flowing back into the ventricle, it 
passes upward on the right side of the spine ; it then arches over across 
the spine to the left side, where it descends through the chest, perforates 
the midriff into the abdomen, and terminates opposite the? fourth lumbar 
vertebra. 



58 CONSTRUCTION OF THE HUMAN MACHINE 

The innominate artery arises from the aorta, passes upward for from 
one and a half to two inches and divides into the right common carotid 
and right subclavian arteries. 

The common carotid arteries arise, the right from the innominate, 
the left from the left side of the arch of the aorta ; they pass up into the 
neck, one on each side of the windpipe, running along a line followed 
by the inner border of the sterno-cleido-mastoid muscles ; at a point 
about an inch below the angle of the lower jaw they divide into an 
internal and external branch. 

The internal carotid arteries pass from the termination of each com- 
mon carotid up to the base of the skull through canals in the temporal 
bones and contribute to the supply of the brain and eyes. 

The external carotid artery, not so deep as the internal, passes up 
the neck to the temples, giving off branches to the larynx, pharynx, 
tongue, scalp, ear, mouth, and nose. The facial branch can be felt as it 
passes across the lower jaw bone, about an inch in front of the angle. 
The temporal artery with its two branches, anterior and posterior, in 
front of each ear, can always be felt and often seen beating under the 
skin. 

The subclavian artery, arising from the innominate on the right 
side and from the aorta on the left, passes up on each side and curves 
over the first rib, but under the collar bone, and again passes down to 
the lower edge of the first rib, where it changes its name to axillary. 
Lying on the first rib, it can be compressed on that bone to stop bleed- 
ing in case of a wound of one of the arteries of the upper extremity. 

The axillary artery is then a continuation of the subclavian from the 
lower border of the first rib, whence it extends across the armpit into 
the arm, where it changes its name to brachial. 

The brachial artery is a prolongation of the axillary, and runs down 
the arm along the inner edge of the biceps muscle into the forearm, 
about an inch below the bend of the elbow, where it divides into the 
radial and ulnar. Its course is approximately shown by a line extend- 
ing from the middle of the armpit to the middle of the elbow. It lies 
on the arm bone, along the inner margin of the biceps muscle and com- 
paratively near the surface, so that it can readily be compressed. 

The radial artery, one of the terminal branches of the brachial, ex- 
tends down the outer side of the forearm to the wrist, on a line extending 
from the middle of the elbow to just within the outer margin of the 
lower end of the radius, where it turns and, winding around the back of 
the thumb and between the thumb and forefinger, finds its way deeply 
into the palm, which it crosses, forming the deep palmar arch by meet- 
ing with a branch of the ulnar. Measuring off the palm in thirds and 
indicating them by horizontal lines drawn across it, the upper line 
would indicate # the deep palmar arch and the lower one, near the fingers, 
the superficial palmar arch, to be considered presently. 



THE ARTERIES 59 

The radial artery is quite superficial in the lower part of the forearm, 
and lies upon the radius, where its pulsation can be felt with great facil- 
ity, for which reason the Pulse is usually felt at this point. The artery 
can also be easily compressed against the bone. 

The ulnar artery, the larger terminal branch of the brachial, extends 
down the inner side of the forearm to the wrist and into the palm, where 
it turns and, crossing the palm and meeting a branch of the radial 
which passes in front of the ball of the thumb, forms the superficial 
palmar arch, which crosses the palm at the junction of its lower with 
its middle third. 

From the palmar arches digital arteries pass down to all the fingers 
and the thumb. 

As the aorta passes down the chest, it gives off a number of small 
branches, among which the intercostal arteries, ten on each side, are 
the most important from the standpoint of emergencies. Giving off 
branches running along the inner surface of the upper and lower mar- 
gins of the ribs, they are likely to be implicated in injuries of the chest. 

Passing then into the abdomen, great arterial branches are given off 
to the viscera, among which may be mentioned the gastric to the 
stomach, the splenic to the spleen, the hepatic to the liver, the renal to 
the kidneys, and the mesenteric to the bowels. 

The common iliac arteries, the branches in which the aorta termi- 
nates at the level of the fourth lumbar vertebra, pass downward and 
outward to the brim of the pelvis, where they in turn divide into two 
branches, internal and external. 

The internal iliac arteries pass into the. pelvis and give off branches 
to the various pelvic viscera. 

The external iliac arteries pass along the back of the pelvis in a 
direction indicated by a line drawn from the navel to the middle of the 
fold of the groin, on each side, where they pass out of the abdomen into 
the thigh and become the femoral arteries. 

The femoral artery, the continuation of the external iliac in the thigh, 
passes down in a direction indicated by a line drawn from the middle 
of the fold of the groin to the inner side of the knee. The upper portion 
of the artery lies quite near the anterior surface of the thigh, and its 
pulsation can readily be felt at this point ; this portion can also be com- 
pressed in case of injury below it. Its lower portion plunges into the 
thigh through a channel called Hunter's canal, passes through the 
muscles and emerges at the back of the thigh, where it receives a new 
name. 

The popliteal artery — so called from the Latin word meaning ham — 
is a continuation of the femoral through the middle of the back of the 
thigh from its emergence on that face of the lower extremity to its 
division into two branches a little below the knee. 

The anterior tibial artery, one of the terminal branches of the pop- 



60 CONSTRUCTION OF THE HUMAN MACHINE 



parotid ciAND«';:X%*>, 

COMMON CAMTSi MTBir- 
exT&MAt. JUGUtAR W9JV- 

mrmiwL jublkar vm~-~ 

CLffJICLE 



eRMHAl [ m yBN^ 




Pi g# 44, —The Principal Arteries in their Relation to Other Structures. 



THE VEINS. 



6l 




jTjg # 45^ — The Veins of the Body. 



62 CONSTRUCTION OF THE HUMAN MACHINE 

liteal, plunges through the leg between the two bones and passes down 
to the ankle, whence it passes on to the back of the foot, where it 
becomes the dorsalis pedis artery, which is distributed to the back of 
the foot. 

The posterior tibial artery, the other terminal branch of the popliteal, 
makes its way down through the calf of the leg to the inner side of the 
ankle, where it curves forward about the internal maleolus into the sole 
of the foot and ends in the plantar arteries, which supply the sole of the 
foot. This artery lies very superficially at the ankle and can be readily 
felt or compressed there. 

The peroneal artery is given off by the posterior tibial soon after its 
origin, and extends down the outer side of the leg to the ankle. 

The Veins. — All veins carrying impure blood from the body back to 
the right side of the heart are called systemic, in contradistinction to 
the pulmonary veins, which carry pure blood from the lungs to the left 
side of the heart. There are four pulmonary veins, two to each lung. 

It being the duty of the systemic veins to carry back to the heart 
the blood which has been brought into the system by the arteries, it is 
natural that the veins should return back to the heart along the same 
lines as the arteries took in passing out. It is found then to be the 
case that one or more veins run parallel to every artery. Veins are, 
however, especially near the surface found unaccompanied by arteries. 

The systemic veins appear in two classes, the veins accompanying 
arteries and penetrating deeply into the tissues, and the superficial 
veins which run in or directly beneath the skin, where they can fre- 
quently and readily be seen. 

Accompanying each of the arteries of the foot, ankle, and leg are 
veins known by the same name as their accompanying artery, or as the 
vena coma of the artery. The anterior and posterior tibial veins unite 
in the bend of the knee to form the popliteal vein which, passing through 
the muscles to the front of the thigh, becomes the femoral vein, which 
in turn, passing up on the inner side of the femoral artery into the ab- 
domen, becomes the external iliac. The external iliac unites with the 
internal iliac to form the common iliac on each side, and these unite in 
turn to form the inferior vena cava, which delivers the blood into the 
right auricle. 

Into the vena cava in the abdomen also empty the hepatic vein from 
the liver, and the renal veins from the kidneys, the latter having removed 
from the blood passing through it the waste matter properly excreted 
there. The hepatic vein carries the blood from the liver, into which 
enters the portal vein formed by the union of the mesenteric, splenic, 
and gastric veins, collecting the blood from the organs concerned in 
digestion. This vessel subdivides in the liver substance to capillaries 
in which the blood, containing matter from the digestive organs, under- 



THE VEINS 63 

goes certain changes before passing out into the general circulation 
through the hepatic vein. It will be observed that the liver contains 
two systems of veins, one the nutritive veins of the gland itself, and the 
other the digestive vessels. 

Of the superficial veins of the lower extremity, two are particularly 
prominent. The internal saphenous vein collects the blood from the 
superficial parts on the inner side of the back of the foot, and passes up 
the inner side of the lower limb, receiving, on its way, contributions 
from numerous tributary veins. Arrived at a point just below the fold 
of the groin, it dips down through a special opening in the fascia of the 
thigh, to enter the femoral vein. 

The external saphenous vein, from a similar origin on the outer side 
of the foot, passes up the middle of the back of the leg and empties into 
the popliteal vein just below the bend of the knee. 

The small veins of the hand unite into the deep radial and ulnar, 
which in turn unite just below the elbow to form the brachials, and 
these become successively the axillary and the subclavian, each of 
them following the course of the arteries of the same name. 

The superficial veins of the palmar face of the forearm are very con- 
spicuous and curious in their arrangement. The median vein passes 
up the middle of the forearm, and just below the bend of the elbow it 
divides into two branches, the median basilic and the median cephalic, 
which form a V in front of the elbow. These veins are joined just above 
the bend of the elbow by the radial and ulnar veins on either side, which 
changes the V in front of the elbow to an M. The ulnar and the median 
basilic unite to form the basilic, which a short distance above the elbow 
enters into the brachial. The radial and the median cephalic unite to 
form the cephalic, which passes up the outer side of the arm to the 
shoulder, where it dips down between the shoulder and the pectoral 
muscles to enter the axillary. 

In the days of bloodletting, these veins were the favorite sites for that 
operation. The median basilic is the larger, but on account of its 
crossing the brachial artery, which is liable to be wounded, the median 
cephalic was often chosen. These veins can readily be shown by tightly 
bandaging the arm above the elbow, when, the progress of the blood to 
the heart being checked, the veins below the bandage will swell and 
become prominent under the skin. 

The external jugular vein collects the blood from each side of the 
face and the superficial portions of the head and neck, and passes down 
the side of the neck to empty into the subclavian vein. These large 
veins can often be seen prominently projecting in the neck. They are 
the vessels usually cut by suicides in " cutting the throat." 

The internal jugular veins collect the blood from either side of the 
brain, and passing down by the side of the carotid artery, receiving by 
the way veins from the neck and head, join with the subclavian to form 
the common trunk, the innominate. 



64 CONSTRUCTION OF THE HUMAN MACHINE 

At the junction of the left subclavian and internal jugular veins, the 
thoracic duct, containing the food digested in the alimentary canal, 
empties its contents into the blood. At the same point on the right 
side the right lymphatic duct enters the veins. 

The innominate veins, on either side, formed by the junction of the 
subclavian and internal jugular veins, unite on the left side of the spine 
just below the first costal cartilage to form the superior vena cava, which 
carries the blood into the right auricle. 

Vascular Glands. — The spleen is an oval glandular organ, five 
inches long by three wide and two thick, situated on the right side of 
the abdomen, presenting no duct, having no secretion, and connected 
with other organs only by the arteries which enter and the veins which 
pass out of it. Just what its functions may be is unknown. Its removal 
does not seem to affect the system in any evident way. It is thought by 
some to be the organ in which red blood-corpuscles are manufactured 
from the white, and that it also presides over the disintegration of the 
red corpuscles when they are worn out. By others it is considered to 
be a safety valve for the blood supplying the digestive organs. During 
the act of digestion these organs demand a much greater blood supply 
than when at rest, and it is thought that the surplus blood in the latter 
case is stored up in the spleen. In chronic malarial affections the 
spleen often becomes greatly enlarged, and is then vulgarly known as 
" ague cake." 

In the neck, just below the chin and in front and on either side of 
the upper part of the windpipe, is another gland possessing no duct, 
producing no secretion, and connected with other parts only by its blood- 
vessels, — this is the thyroid gland or "throat sweetbread." This, too, 
is thought to have something to do with the formation and destruction 
of the blood corpuscles, but its function is not known positively. It is 
this gland, become greatly enlarged, which forms the tumor in front of 
the neck in "goitre." 



CHAPTER VIII 

THE SPEAKING AND BREATHING APPARATUS —THE 
LARYNX AND THE LUNGS 

From the posterior portion of the cavities of the mouth 
and nose is suspended a combination of two organs which 
greatly resembles an inverted hollow tree. The trunk of the 
tree is formed by the larynx or organ of speech and the 
trachea or windpipe ; the trachea divides into two branches 



THE SPEAKING AND BREATHING APPARATUS. 65 



called bronchi or bronchial tubes, and these in turn divide — 
the process of division keeping on until it finally terminates 
in very minute tubes or pouches, called the pulmonary vesi- 
cles, and these vesicles taken together form the lungs or, as 
the butchers call them, the " lights." 

Looking into the mouth, an arch will be seen at its back part, and 
this arch marks the end of the mouth proper. A similar condition 
exists at the posterior part of the nose. And the cavity into which both 
the nose and the mouth open is called the pharynx. In its lower 
portion are two apertures, that of the larynx in front and that of the 
oesophagus or "gullet" behind. 

The larynx, the enlarged upper part of the trachea or windpipe, is a 
short, irregularly shaped tube, in which is located the organ of speech. 
At its upper limit is a cover composed of cartilage, which closes the 
air passage when food is swallowed. At the moment of swallowing, the 
larynx is drawn up against this cover, the epiglottis, and the cavity is 
completely closed, so that, although the food passes directly over it, 
none can enter. The accidental lifting of the epiglottis during the act 
of swallowing, as sometimes occurs 
during laughter, allows food to enter 
the larynx, and the effort to expel it 
produces the choking and coughing 
always seen at that time. 

The larynx can be felt from the 
outside in front of the neck, where it 
appears as a hard lump just under 
the chin, known as "Adam's apple," 
from an old story that it was a por- 
tion of the forbidden fruit swallowed 
by the common ancestor of humanity, 
but which " stuck in his throat." It 
is composed of a number of cartilages 
bound together by ligaments, and 
moved upon one another by mus- 
cles. It is about an inch and a half 
long and an inch in diameter. 

Inside of the larynx are two nar- 
row fibrous bands extending across it 
from front to back : these are called 
the vocal cords, and they are relaxed 

or tightened by the laryngeal muscles moving the cartilages. The 
vibration of the vocal cords, caused by the air passing over them from 
the lungs, produces the voice. 




Fig. 46. — Diagram of human larynx, 
trachea, bronchi, and lungs, show- 
ingthe ramification of the bronchi, 
and tne division of the lungs into 
lobules. 



66 CONSTRUCTION OF THE HUMAN MACHINE 

The larynx is constructed on the principle of a reed organ. It con- 
tains but one pipe, but that one is susceptible of such adjustment that 
no others are necessary. The vocal cords are the reeds. 

The larynx is continuous below with the trachea or windpipe, a tube 
composed of rings of cartilage, incomplete behind, and of elastic fibrous 
membrane. These rings keep the tube constantly open, and prevent 
interference with the passage of air by the collapse of the windpipe. 
The trachea is from three-quarters of an inch to an inch in diameter, 
and extends down the middle of the neck for four or four and a half 
inches into the chest, where, opposite the third dorsal vertebra, it divides 
into the right and left bronchi, one for each lung. 

The bronchi, constructed in exactly the same manner as the trachea, 
continue branching by dividing and subdividing to the terminal lobules 
of the lung. The rings, as the bronchi decrease in size, become scarcer 
and more irregular until they are but mere flakes of cartilage, and when 
the tubes are reduced to a diameter of one-fortieth of an inch, they 
disappear entirely. The tubes, however, still continue branching until 
the walls consist of but a thin elastic membrane, which expands into a 
little sac or lobule (Fig. 48), the walls of which are pouched out irregu- 
larly into little pockets called air vesicles or cells. The air passages 
are lined with mucous membrane, presenting upon its surface epithelial 
cells covered with cilia or hair-like processes, which by a continual 
waving motion carry off mucous and other secretions. 

The lungs or " lights " thus formed are two in number, one in each 
side of the chest. The fact of their substance consisting of air cells, 
with elastic walls, gives them a light, spongy appearance and feeling. 
They are covered externally by a smooth serous membrane, the pleura, 
which also lines the inner walls of the chest, providing smooth surfaces 
to avoid friction in the movements of the lungs in breathing. Although 
these two pleural surfaces are ordinarily in so close contact as to leave 
no vacancy between them, the cavity which may be formed is called the 
pleural cavity. When these membranes become inflamed, we have 
pleurisy, and the dropsical secretion which is then thrown out makes 
the cavity between the two pleural surfaces apparent. 

Between the lungs lie the heart in the pericardium, the oesophagus 
or "gullet," the large bronchi, and the great vessels. Below the lungs 
lies the dome-like diaphragm or midriff, a most important factor in 
breathing. 

The pulmonary veins and arteries penetrate to the substance of 
the lungs with the bronchi, dividing and subdividing with them until, 
in the walls of the ultimate divisions, the air cells are found in the 
capillaries of the lungs. Between the blood in the capillaries and 
the air in the air vesicles, nothing intervenes except the thin walls of 
the vessels and the vesicles, so that it is possible for the blood readily 
to cast off its carbonic acid and other impurities into the air of the 



BREATHING OR RESPIRATION. 



6 7 




Fig. 47. — Lobule of lung. 
aa. Exterior of lobules. 
bb. Vesicles of lung. 
cc. Smallest bronchi. 



lungs, and absorb from it the supply of oxygen needed for the nutrition 

of the system. The enormous extent of the walls of the air cells is 

evident when it is considered that the capilla -ics contained in them 

must be able to contain a quantity of blood 

equal to that contained in the capillaries of all 

the rest of the body taken together. It has 

been estimated that the surface afforded by 

them is equal to more than ten thousand 

square inches. How vast the number of these 

cells is, may be inferred from this fact. 

Breathing or respiration consists of 
the alternate enlargement and contrac- 
tion of the chest, by means of which 
air is drawn into or forced out of the 
lungs. Breathing air into the lungs is 
called /aspiration, and expelling it fro77i 
the lungs is called <?.rpiration. 

The chief agent in breathing is the diaphragm or midriff, 
the great dome-like muscular floor of the chest, which, when 
its fibres 'contract, flattens down the 
dome, increasing the amount of space 
in the chest, and at the same time 
causing the abdomen beneath it to 
swell out. In addition to this, the 
capacity of the chest is further in- 
creased by the muscles which draw 
the ribs upward and outward. These 
acts create a vacancy in the chest, 
which is filled by the air rushing 
through the windpipe into the air cells 
of the lungs. This is inspiration. 
Expiration, or breathing out, is a 
much more simple act, and consists simply in the relaxation 
of the muscles causing inspiration, — the diaphragm resumes 
its dome-like projection into the chest, the ribs drop to their 
original position, and the elastic lungs contract to adapt 
themselves to the reduced capacity of the chest. 

These movements occur from fifteen to eighteen times a 
minute in health. 




Fig. 48. — Section of a single 
lobule of human lung. 

a. Ultimate bronchial tube. 

b. Cavity of lobule. c,c,c. 
Pulmonary cells or vesicles. 



CONSTRUCTION OF THE HUMAN MACHINE 



In case of an obstruction in the windpipe, or any other interference 
with the free entrance and exit of air, the breathing is much more diffi- 
cult, and in this case most of the muscles of the chest, neck, and 

shoulders, and some on the 
back, join with the muscles 
named in the effort to expand 
the chest — the act then being 
called forced respiration. 

There are a number of 
common acts closely allied 
to breathing which it may be 
interesting to consider here. 
Sighing consists of a pro- 
longed and almost noiseless 
inspiration, followed by a sud- 
den noisy expiration, due to 
the elastic recoil of the lungs 
and chest walls. 

In hiccup the inspiration 
is sudden, from the spasmod- 
ic action of the diaphragm, 
causing the air to rush sud- 
denly through the larynx and 
produce the peculiar sound. 

Coughing consists first of 
an inspiration and then, when 
the lungs have been filled, 
the air is not immediately let 
out through the larynx, which 
is momentarily closed so 
that the abdominal muscles 
strongly act in pushing the 
viscera up against the dia- 
phragm, and increase the pressure on the air in the lungs, until the 
tension is sufficient to overcome the spasmodic closure which opposes 
its passage. This makes it possible to drive a stream of air with con- 
siderable force upon any mass of mucus or other obstructing matter 
and expel it. 

Sneezing is similar to coughing, except that the force of the expi- 
ratory act is spent on the nostrils. 

Speaking has already been referred to ; it should be observed that 
the vocal cords produce the sounds only, and that the words are formed 
by the tongue, teeth, lips, and palate. 

Singing is a modification of speaking, the key being altered by vari- 
ations in the tension of the vocal cords. 




Fig. 49. — The changes in the chest during 
breathing. In A, the ribs are seen to be lifted 
up and the diaphragm pressed down to in- 
crease the capacity of the chest in inspiration. 
In B, the ribs are seen to be drawn down, 
and the diaphragm is lifted up, diminishing 
the capacity of the chest in expiration. 



BREATHING AND THE BREATH 69 

Sobbing, laughing, and yawning are still other modifications of the 
act of breathing. 

In each respiratory act, during ordinary breathing, from twenty-five to 
thirty cubic inches of air are drawn in and expelled from the lungs. This 
quantity of air, constantly flowing in and out, is known as the tidal air. 
But much more than this quantity can be drawn into the chest. After 
an ordinary inspiration, about a hundred cubic inches of air can be 
drawn into the lungs in addition to that already there ; this is the com- 
plemental air. On the contrary, after an ordinary expiration, about a 
hundred cubic inches of air can be expelled from the lungs by a forcible 
expiration, and this is the reserve air. But after every effort lias been 
made to empty the air cells, there still remains a quantity of air equal to 
about a hundred cubic inches ; this is the residual air. The amount 
of air which can be forcibly expired after taking the deepest possible 
inspiration, is the vital capacity, and, including the tidal, comple- 
mental, and reserve air, amounts to about 225 cubic inches. 

The complemental and reserve air are drawn upon in running, row- 
ing, or other violent exercise, at which time the full vital capacity of the 
lungs is often employed. 

The air which we inspire contains seventy-nine parts of 
nitrogen and twenty-one parts of oxygen, with a mere trace 
of carbonic acid and other matters of animal or vegetable 
origin. When, however, it is returned to the atmosphere by 
^jrpiration, its composition has been changed. None of the 
nitrogen has been lost — indeed, it rather gains in amount ■; 
but five parts of the oxygen have been lost, while the car- 
bonic acid has increased by four and a half parts. Light as 
are these two gases, a man ordinarily throws out in the breath 
more than two pounds of carbonic acid a day, and consumes 
in the lungs a trifle less of oxygen. A large quantity of water 
and some animal matter are also thrown out from the lungs. 

The blood coming into the lungs from the body is laden 
with carbonic acid to be expelled there. This gas, when 
breathed in large quantities, is a fatal poison. 

Oxygen in the air that is breathed is an absolute necessity, 
and its absence for but a short period will cause rapid death. 
In a tightly closed room the oxygen of the air may be used 
up by repeatedly breathing it until, unless there is some 
means of renewing the' supply, smothering will close life just 
as surely as if a pillow were pressed tightly over the face. 
The chinks about the doors and windows often allow the 



yO CONSTRUCTION OF THE HUMAN MACHINE 

passage of sufficient fresh air into a room to prevent death, 
while at the same time not admitting enough to fully supply 
the demands of the system for oxygen ; headache, languor, 
and unaccountable weakness result from this partial smother- 
ing. It must be admitted, however, that the disagreeable 
sensations are probably due also to some extent to breathing 
again the decaying animal matters thrown out in small quan- 
tities in each breath. The continual breathing of impure air 
with an insufficient supply of oxygen has a deleterious effect 
upon the health, and many deaths have been hastened if not 
directly produced by it. 

This is the reason why ventilation or the supply of ample 
quantities of fresh air has been so strongly dwelt upon by 
physicians and sanitarians ; and why the medical man insists 
so earnestly upon the desirability of providing sleeping and 
living rooms with suitable ventilators, and with ample means 
for keeping them open. 



CHAPTER IX 

THE DIGESTIVE APPARATUS — THE ALIMENTARY CANAL 
AND ITS APPENDAGES 

The digestive apparatus is that portion of the human ma- 
chine in which material destined to repair the wear and tear 
is worked up into a condition suitable for its purpose. The 
process by which the oxygen of the air has been conveyed 
into the system through the lungs has been described, and it 
remains to refer briefly to the manner in which other materi- 
als are adapted to the nutritive process. 

The forms in which foods are absorbed are four in number : 
(i) Nitrogenous matter, of which the egg is a perfect exam- 
ple. (2) Fats. (3) Sugar; and (4) metals. All these are 
present at the same time in some articles of food, such as 
milk,, while others may contain but one or two. The object 
of digestion, then, is to convert these four varieties of food 



THE DIGESTIVE APPARATUS Jl 

into a form suitable for introduction into the blood, and 
carriage to the system by it. 

The first step in the process of digestion occurs in the mouth. Here 
the food is chewed by the teeth into a mass of fine particles, each of 
which can readily be reached by the digestive juices. The teeth have 
been fully described in connection with the anatomy of the jaws. They 
are assisted in their work by the tongue, a large, free, muscular organ, 
which keeps the food between the teeth during the act of chewing, and 
forms it into a mass of a shape suitable for swallowing. 

Opening into the mouth are three pairs of glands like minute bunches 
of grapes, which also contribute to digestion. They secrete the saliva 
or "spittle." The parotid glands lie just below the temples on either 
side ; their location will be remembered by every one when it is re- 
called that it is the inflammation and swelling of these glands which 
causes the " mumps." Under the lower jaw and at the root of the 
tongue are other salivary glands, the submaxillary and sublingual 
glands. Chewing the food mixes it with saliva, which not only lubri- 
cates the mass and makes it easy to swallow, but changes a portion of 
the starches it contains into sugar. Bread, beans, corn, or wheat can- 
not be absorbed without change ; the starch, of which they chiefly con- 
sist, must first be transformed into sugar. 

Up to this point the food has been under the control of the will, but 
now it is pushed by the tongue back into the pharynx, over the epi- 
glottis, where it is seized by the pharyngeal muscles and passed into the 
oesophagus or " gullet," and the will can control it no longer. A knowl- 
edge of this fact is sometimes useful in administering pills to children 
or animals ; if the mouth be opened and the pill be pushed back to the 
root of the tongue, it passes beyond the child's control and into the 
stomach. A mouthful of water swallowed immediately after will help 
to carry it into the stomach. 

The alimentary canal is a musculo-membranous tube from twenty 
to thirty feet in length, with a diameter varying at different points, re- 
ceiving ducts connecting it with certain accessory organs, and bearing 
different names in its different parts. 

The oesophagus or gullet, the first division of the alimentary canal, 
runs behind the windpipe and the heart, in front of the spine and be- 
tween the lungs, through the neck and chest, perforates the diaphragm 
or midriff, and ends in an expansion of the canal, called the stomach. 
It is about ten or eleven inches long from the pharynx opposite the fifth 
cervical vertebra to the stomach opposite the ninth dorsal vertebra. 
Its muscular coat is composed of involuntary fibres so arranged as to 
carry the food downwards. When not dilated by food, it is collapsed. 

The stomach (Fig. 50) is the most dilated portion of the alimentary 
canal, and it is the principal organ of digestion. It appears in the form 



J2 CONSTRUCTION OF THE HUMAN MACHINE 

of an irregularly conical bag with tubes opening into either end, and 
lies chiefly on the left side of the abdomen, under the diaphragm, and 
protected by the lower ribs. Its size is subject to greater variations 
than any other organ in the body, according as it is full or empty, and 
according to individuals ; but it averages twelve inches long and four 
in diameter, with an average capacity of about four pints. The oesoph- 
agus enters at the larger extremity, and its opening is called the cardiac 
orifice, from its proximity to the heart; its other opening, connecting it 
with the small intestine, is called the pyloric orifice, and is guarded by 
a sort of valve, the pylorus or " gate keeper." 




i 

Fig. 50. — A section of the stomach and upper bowel, showing the internal arrange- 
ment, the location of the hepatic and pancreatic ducts from the liver and pan- 
creas respectively, and the valvulae conniventes. 

The walls of the stomach are formed (a) by an external smooth serous 
coat, derived from the peritoneum, the general lining of the abdomen ; 
{b) two muscular coats extending horizontally and perpendicularly, 
and by their contractions producing the peculiar movements of the 
organ ; (c) an internal lining of mucous membrane continuous with 
that of the intestine below and, through the oesophagus, with that of the 
mouth above. In the mucous membrane are found a multitude of 
glands which, when food comes into the stomach, pour forth the gastric 
juice, a sour liquid which acts upon the food in the stomach and con- 
tinues the process of digestion. So long as any food remains in the 
stomach, the muscles keep up a churning movement which thoroughly 
mixes the contents with the gastric juice, and greatly aids the digestion. 



THE STOMACH AND BOWELS 73 

A small part of the food is completely digested here and absorbed into 
the blood in the capillaries of the stomach ; the remainder is converted 
into a thick, whitish fluid called chyme, which passes on into the small 
intestine, where it is acted upon by other agents. 



Fig. 51. — The contents of the abdomen. The liver is shown at the top, drawn up so 
as to show the gall bladder underneath. The stomach is seen on the right with 
the duodenum passing out from it. Crossing the abdomen just below the stomach 
is the large intestine, which may be traced up the right side of the body, across, 
and down the left side. In the centre is seen the small intestine gathered into a 
twisted mass. 

At the pyloric end of the stomach, and under the left end of the liver, 
the alimentary canal contracts again into a slender tube called the small 



74 CONSTRUCTION OF THE HUMAN MACHINE 



intestine, bowel, or gut. About one inch in diameter and twenty feet 
long, it is attached to the lumbar portion of the spine by a membrane 
called the mesentery, which is disposed in numerous folds to adapt 
itself to the turns of the intestine, which is rolled into a mass suitable to 
lie in the cavity of the abdomen. The small intestine is divided by 
anatomists into three parts : the first eight or ten inches is known as 
the duodenum ; the two fifths following is called the jejunum, from the 
Latin word meaning empty, because it is usually found empty after 
death ; the remaining three fifths is known as the ileum, from the Greek 
word meaning to twist, because of the numerous folds into which it is 
thrown. The small intestine presents a serous, a muscular, and a mu- 
cous coat. The mucous coat presents numerous folds called valvulae 
conniventes (Fig. 50), which greatly increase the amount of surface 
coming into contact with the food. It also presents an immense num- 
ber of little projections called villi, which give it a velvety appearance : 
through the villi the digested food passes into the blood. A number 
of glands are also found producing a fluid, the " succus entericus," 
which promotes digestion. Into the small intestine open ducts from 
the liver and pancreas (Fig. 50), giving passage to fluids fulfilling a 
most important function in digestion. 

There are two important glands which pour into the small intestine 
fluids essential to digestion : these are the liver and pancreas. The 
liver is the largest gland, and indeed the largest single organ, in the 

body, weighing three or 
four pounds, and meas- 
uring ten or twelve inches 
in breadth, six or seven 
in thickness, and two or 
three in depth. It lies 
on the right side of the 
abdomen, and is slung 
by its ligaments high up 
against the diaphragm 
and under the lower ribs. 
It is a large, reddish 
brown organ, marked by 
a number of fissures di- 
viding it into lobes, in 
one of which lies a membranous bag, the gall bladder, in which is 
held in reserve a quantity of the secretion of the liver. It is connected 
with the small intestine by the portal vein, which collects the blood from 
the bowels, and by the gall duct, which carries its secretion into them. 
The liver has two chief functions : ( 1) It produces the bile, a yellowish 
brown fluid of an intensely bitter taste, which (a) assists in converting 
the contents of the small intestine into a form suitable for absorption 




Fig. 52. — The liver seen from below. 




THE PANCREAS AND LARGE INTESTINE /5 

into the blood, and {b) acts as a stimulant to the muscles of the bowel, 
thus producing some cathartic action. (2) It completes the digestion 
of certain portions of the food already absorbed into the blood, and 
produces sugar, the burning of which aids in maintaining the heat of 
the body. 

The pancreas, which derives its name from the Greek words meaning 
"all-flesh," is known to butchers as the " belly sweetbread," in distinc- 
tion from the thyroid gland or " throat sweetbread," and the thymus 
gland or " breast sweetbread." It is a tongue-like mass lying across the 
back of the abdomen with its smaller extremity or " tail" on the left, 
is six or eight inches long, and from a half an inch to an inch thick. 
From its larger end passes out the pancreatic duct, which joins with the 
bile duct from the liver 
and enters the small 
intestine. The pancre- 
atic juice completes the 
digestion of the digesti- 
ble portions left un- 
touched by the other 
fluids, but its chief func- 
tion is the division of Fig. 53.— The pancreas, 
fats and oils into parti- 
cles sufficiently minute to permit of absorption into the blood. The 
digested food is now a milky fluid called chyle. 

The process of digestion, then, begun by finely dividing the food 
and converting a part of the starch into sugar in the mouth, is con- 
tinued by the churning movement and the mixture with the gastric 
juice in the stomach, converting the food into chyme. The chyme, in 
the small intestine, mixes with the bile and the pancreatic and intestinal 
juices, which convert it into chyle. Certain portions of the digested food 
are absorbed into the circulation by the veins of the stomach, and 
others pass through the veins of the mesentery and the portal vein into 
the liver, while still others are absorbed by a set of vessels called lacteal 
from their milky white appearance when full of chyle, and which pass 
from the villi of the intestine into the mesentery and through small 
glands also in the substance of the mesentery, into the thoracic duct, 
which empties them into the left innominate vein, whence they pass into 
the general circulation. 

The small intestine, just above the right groin, runs into the large 
intestine (Fig. 51), which, about five feet in length and thrice the size 
of the lesser bowel, passes up to about the level of the " navel," arches 
across the abdomen, and descends on the other side, where, passing to 
the middle line, it descends and opens on the external surface of the 
body. A valve — the ileo-caecal valve — at the junction of the small 
with the large intestine prevents the return of matter which has passed 



?6 CONSTRUCTION OF THE HUMAN MACHINE 

into the latter. A dilated pocket at the beginning of the large intestine 
is called the caecum, and from it passes a worm-like process called 
the appendix vermiformis, the function of which is unknown, but which 
is of great surgical interest from its liability to become inflamed and 
produce an abscess which is exceedingly dangerous to life. The re- 
mainder of the large intestine, except the last six or eight inches, is 
called the colon. The last portion is called the rectum, and terminates 
externally in the anus or fundament. But little if any digestive action 
goes on in the large intestine, the principal work of which is absorption. 
As its contents approach its lower extremity, they become more and 
more solid and free from nourishment, until finally only the waste 
matter is left, in the form of excrement, which is thrown off. 



CHAPTER X 

THE APPARATUS FOR THE DISPOSAL OF WASTE — THE 
EXCRETORY APPARATUS 

A considerable amount of matter is introduced into the 
alimentary canal which cannot be utilized for the nourish- 
ment of the system, and the various operations of the human 
machine cause parts to be worn away which, in the process 
of repair, are replaced by new ones and thrown off. This 
process of casting off useless, worn, or waste matters from 
the body is called excretion. 

Excretion is accomplished through the skin, the lungs, the 
rectum, and the kidneys with the bladder. 

In the skin, which has been described in the chapter devoted to it, 
are millions of glands through which water is extracted from the blood 
and thrown off — the sweat glands, producing the perspiration. The 
evaporation of the perspiration is an important provision for keeping 
the surface of the body cool, and is the original utilization of the prin- 
ciple which the soldier adopts when he wets the canvas cover of his 
canteen in hot weather to cool its contents. Perspiring is constantly 
going on, although it is imperceptible except during unusual physical 
exercise or great heat, when the sweat is poured out faster than it can 
be removed by evaporation, and it stands out in drops upon the skin. 
When perspiration is unusually abundant, the amount of water excreted 
by the kidneys is diminished. In addition to the water, the perspiration 



THE EXCRETORY APPARATUS 



77 



carries out of the system salt, — which can readily be appreciated by the 
taste, — carbonic acid, a poisonous exhalation called urea, and other 
noxious substances. In case of extensive injuries, such as burns, where 
a considerable extent of the skin is injured so that its excretory functions 
cannot be exercised, and the blood relieved of the impurities collecting 
there, serious and often fatal results may follow. 

The lungs, which have been considered in the chapter on the breath- 
ing and speaking apparatus, throw off more than two pounds of carbonic 
acid a day, a little less than a pint of water, and about three grains of 
decaying animal matter and ammonia. 

Reference to the rectum has been made in the preceding chapter in 
connection with the large intestine. As the food taken through the lips 
passes down the alimentary canal, it comes in contact with various juices 
which prepare the nourishing parts of 
it for absorption, and these portions 
are gradually passed into the blood 
at points throughout the stomach and 
bowels until, when it arrives in the 
lower bowel, only the refuse matter 
which cannot be utilized is left. This 
takes the form of excrement and is 
cast off. 

The kidneys are two glandular or- 
gans situated in the loins on the pos- 
terior wall of the abdomen on either 
side of the spinal column. They are 
shaped like large beans, and are about 
four inches long, two and a half broad, 
and an inch and a half thick; they 
weigh about a quarter of a pound 
each. They are composed chiefly of 
arteries, veins, and urinary tubes, and 
these are combined in such a way as 
to produce a cortex or bark-like sub- 
stance and a medullary or central sub- 
stance. The arteries are larger than 
the veins, so that a greater bulk of 
blood is brought into the kidneys than 
is carried away from them ; the bulk 

is reduced by the passage of a portion of the water with certain waste 
products, notably urea, into the urinary tubules. The extremity of each 
urinary tubule is expanded into a sac (Fig. 55), into which a small 
arterial twig runs and is subdivided and turned and twisted upon itself, 
until it passes into a minute venous tube of a somewhat smaller size ; the 
blood then being pushed through into the vein, the water is forced out 




Fig. 54. — A kidney divided length- 
wise. I. The cortex. 2. Pyra- 
mids of urinary tubes. 3. 3. Apex 
of pyramids. 4. Pelvis of the 
kidney. 5. Ureter. 6. Renai ar- 
tery. 7. Renal vein. 8. Small 
vessels in the kidney. 



y8 CONSTRUCTION OF THE HUMAN MACHINE 



through the walls of the small vessels into the enclosing sac and carried 
off by the urinary tubule. The sacs with the intertwined vessels are 
called malpighian tufts. These tufts form the principal portion of the 
cortical substance of the kidney. Besides the water removed from the 

blood in the kidneys, a considerable 
number of chemical salts are excreted 
with it, and some waste animal com- 
pounds, particularly urea, a noxious 
substance referred to in connection 
with the perspiration. The fluid thus 
formed of water, salts, and animal 
compounds is a yellowish liquid 
known as urine. 

The urinary tubes pass down to a 
cavity at what corresponds to the hilus 
of the bean, and is called the pelvis of 
the kidney, from which passes out a 
tube about the size of a goose quill, 
and runs down along the back to the 
bladder : this is the ureter, and its 
function is to carry the urine from the 
kidneys to the bladder. A little more 
than three pints of urine is formed 
during a day. 

The urinary bladder is a bag formed 
of involuntary muscle and membranes, 
lying in the cavity of the pelvis. Its 
function is to store the fluid continu- 
ally secreted by the kidneys until such 
time as is convenient to discharge it. 
When moderately distended, it con- 
tains about a pint, and is oval in form, 
measuring about five inches in height and three in breadth. In the 
bladder chemical salts may settle and form a hard deposit, which in- 
creases in size until it resembles a veritable stone : this is " stone in the 
bladder." The act of discharging the contents of the bladder is under 
the control of the will, and occurs several times a day. 




Fig. 55. — Greatly enlarged diagram, 
showing the arrangement of the 
parts of the kidney. I. Uri- 
nary tubules. 2. Malpighian tuft. 
3. Artery. 4. Artery entering the 
tuft. 5, 6. Malpighian tuft, with the 
sac removed. 7, 7, Veins emerging 
from the tufts. 8, 8. Veins. 



THE SENSES TOUCH AND TASTE* 79 

CHAPTER XI 
THE PERCEPTIVE APPARATUS — THE SENSES 

The senses are the portals of the intelligence : for through 
them all perceptions hncl their way to the seat of the intelli- 
gence in the brain. They comprise touch, taste, smell, hear- 
ing, and sight. 

The sense of touch and its relation with the brain through 
the sensory nerve filaments distributed throughout the body 
has been described in connection with the nerves. In the 
sense of touch is also included the appreciation of heat and 
cold. In connection with the bones reference has been made 
to the wonderful mechanism of the hand. A great portion 
of the usefulness of that member is due to the sense of touch, 
which is most highly developed on the palmar face, and in 
particular at the tips of the fingers. 

The sense of taste, situated in the cavity of the mouth, 
consists in the perception of the flavor of articles, particularly 
in their relation to food. A sweet, a sour, a bitter, or a saltish 
taste is understood by every one. Dependent upon taste is 
the appetite. The study of the gratification of the taste has 
been the life work of not a few, and the art of cookery — 
the preparation of food in such a manner as to gratify the 
taste — is a vocation well worthy the attention of a higher 
grade of mind than is wont to be devoted to it. 

The adaptation of food to the taste has a hygienic value ; for experi- 
ence has shown that, as a general rule, the most savory food is the most 
easily digested. There seems to be a correlation between the sense of 
taste and that of sight as referred to the perception of colors, although 
the former has not been developed to the same extent as the latter. 
There should be considered, in cooking, a harmony of savors, in order 
to attain full palatability, just as in painting a harmonious combination 
of colors is needed to please the eye. 

The sense of taste is most highly developed in the tongue, and the 
full advantage of the sense is obtained only after the food has been 
passed back over the tongue to the pharynx. The object to be tasted 



8o CONSTRUCTION OF THE HUMAN MACHINE 



must be moistened in order to make its impression upon the nerves of 
this sense. The perception of taste is carried to the brain by a branch 
of the trifacial and by the glosso-pharyngeal, both cranial nerves, the 
latter supplying the back of the tongue, and the former the tip. 

Upon the top of the tongue toward the back are seen eight or ten 
minute prominences arranged in the form of a V : these are the circum- 
vallate papillae, and contain the terminations of the filaments of the 
glosso-pharyngeal nerves. Along the sides and tip are a number of 
smaller prominences called the fungiform papillae, containing the ter- 
minations of the lingual branch of the trifacial nerve. A third set, 
called the filiform papillae, are distributed over the tongue, but are 
probably not involved at all in the sense of taste. . The back portion of 
the tongue perceives taste the best, although the tip more quickly appre- 
ciates sweet and pungent savors, the bitter and savory flavors being best 
perceived at the back. 

The sense of smell consists in the perception of odors. 
This sense is located in the upper chamber of the nose, and 
is due to the filaments of the olfactory, the first cranial nerve, 

which form a network on the 
mucous membrane of that cav- 
ity (Fig. 56). 

Odors are minute particles given 
off by the substances from which 
they emanate. And it is necessary 
for the action of the sense of smell 
that air, bearing the odor, should be 
breathed through the nose, when the 
particles come in contact with the 
mucous membrane where the sense 
is located. 




Fig. 56. — The nose divided down the 
middle line to show the distribution 
of the olfactory nerve. The roof of 
the mouth is seen below. 



The sense of hearing consists 
in the appreciation of sonorous 
or sound-producing vibrations. 
That these vibrations are better transmitted by solid bodies 
even the savage knows, when he puts his ear to the ground 
to hear the approaching footsteps of his enemy. In the same 
way sound can be transmitted to the auditory nerve through 
the bones of the head as well as through the orifice of the 
ear, as can be shown by taking a watch between the teeth 
and stopping the ears with the ringers. 



SENSES OF HEARING AND SEEING 




It is rarely possible, however, for the ear to be connected 
with the source of sound vibrations by solids, and they are 
usually transmitted by the air and through the ear. 

The ear, or organ of hearing, is coinposed of the pinna, the auditory 
meatus, the tympanic membrane, the middle ear, and the internal ear. 
The pinna is the external portion, the object of which is to collect the 
vibrations into the orifice of the 
auditory meatus. This portion is 
not of much importance in man, 
but in the rabbit or the donkey its 
importance is very great. The vi- 
brations collected by the pinna then 
pass into the auditory meatus, 
which is a short tube closed at its 
inner end by a thin, strong mem- 
brane stretched tightly across it, 
the tympanic membrane. On the 
other side of the tympanic mem- 
brane is another cavity, the middle 
ear, closed at its inner end by bone, 
in which, however, are apertures also 
closed with membrane ; through the 
middle ear and connecting the tym- 
panic with the other membrane is a 
chain of very small bones called the 
ossicles of the ear. Beyond the 
middle ear is the internal ear, a 
cavity filled with fluid, in which 

reside the terminations of the auditory nerve, the cranial nerve which 
carries perception of sound to the brain. In order to reach the intelli- 
gence, then, the vibrations have to pass through the air, the tympanic 
membrane, the ossicles, the membrane of the internal ear, the fluid of 
the internal ear, and the auditory nerve. 

The sense of sight is the perception of form, size, color, 
light, or shade. It is the most important of the senses, and 
gives origin to the greatest number of perceptions. If a room 
be darkened, and light be admitted only through a small 
aperture, an image of the external objects opposite to the 
aperture may be seen on the wall where .the rays of light 
strike. Were the rays of light further concentrated by a 
lens, the image would be still more distinct. The photog- 
rapher's camera is but a reproduction of this room on a small 



Fig. 57. — The ear, the temporal bone 

being divided to show the internal 
structures. I, I, I. The pinna 2. 
The auditory meatus. 2'. The mem- 
brana tympana. 3. The middle ear. 
6. The internal ear, showing the 
cochlea and semicircular canals. 



82 CONSTRUCTION OF THE HUMAN MACHINE 

scale, and the eye is the original embodiment of both. It is 
a dark cavity, upon the posterior wall of which the filaments 
of the optic nerve are spread, so that when the light passes 
into the cavity through the pupil, an image of the objects 
opposite to it is formed on the posterior wall and transmitted 
by the optic nerve to the intelligence in the brain. 

The eye is a ball surrounded by three coats, the internal of which — 
the retina — is an expansion of the optic nerve, and destined to receive 
the impressions of sight; the external in front is called the cornea, and 
is a transparent membrane ; behind, it is a strong, whitish opaque 
membrane, called the sclerotic. The middle coat is incomplete in 
front, where it is called the iris, and the opening in the centre is called 
the pupil ; the iris may be blue, gray, brown, or black, and from it the 




Fig. 58. — A section of the eye. I. The sclerotic coat. 2. The cornea, connecting 
with the sclerotic coat by a bevelled edge. 3. The choroid coat. 6, 6. The iris. 
7. The pupil. 8. The retina. 10, II, II. Chambers or cavities of the eye, con- 
taining the aqueous humor. 12. The crystalline lens. 13. The vitreous humor. 
15. The optic nerve. 14, 16. Arteries of the eye. 

eye derives its color; the middle coat behind is a dark-brown mem- 
brane, profusely supplied with blood-vessels, and called the choroid 
coat. Set in front of the eye, just back of the iris, is a lens, the crys- 
talline lens, and before and behind the lens the cavities are filled 
with transparent matter called respectively the aqueous and vitreous 
humors. The eyeball is set into the orbit of the skull, and protected by 
the overarching brows and by the curtain-like eyelids, and the visible 
portion of the eyeball, except the cornea, is covered by the conjunctiva, 



THE EYE 83 

a membrane very abundantly supplied with blood-vessels and very sub- 
ject to inflammation. The inflammation of the conjunctiva is the ordi- 
nary " sore eyes," and is technically known as conjunctivitis. 

In using a burning-glass, it will be noticed that the glass has to be at 
a certain distance from the object to be burned in order to affect it. 
This is the distance at which the rays of light are concentrated by the 
lens, and is called its focus. Glasses of varying degrees of convexity 
have different foci. The crystalline lens of the eye has certain muscles 
which cause it to adapt itself to varying foci ; this is the " power of 
accommodation." In some persons the lens is so altered that it cannot 
adapt itself to all circumstances. If the person can see better at dis- 
tances, the lens is not convex enough, and the focus for near objects 
passes behind the retina ; such a person is hypermetropic or " far- 
sighted," and needs convex glasses. If the person can see only at short 
distances, the lens is too convex, and the focus strikes in front of the 
retina, and the person is myopic or " near-sighted." Old people are 
often afflicted with far-sightedness, because, as age advances, the crys- 
talline lens becomes harder and the muscles of accommodation cannot 
make it convex as before: this is called presbyopia or "old eyes." 
Sometimes the lens is not symmetrical, and the focus is not clearly 
thrown upon the retina: this is astigmatism, and a person affected with 
it would want a glass formed of a segment of a cylinder. 

It not infrequently happens that the eye cannot distinguish colors. 
This is called " color-blindness." In some cases the power of discrimi- 
nating between colors is entirely lost ; in others the recognition of certain 
colors only is absent. A man may be green blind or red blind, for 
example. This defect is of vital importance, particularly in railway or 
steamship management, where signals are made by different colored 
flags or lights, as well as in many other avocations where the percep- 
tion of colors is necessary. 



Part II 

THE IMPLEMENTS OF REPAIR 



CHAPTER XII 
GERMS, THEIR ACTION AND ITS CONTROL 

When a ray of sunlight shines into a room, the sunbeam 
will be seen to be full of minute particles or motes floating in 
the air. These are not observed by the naked eye except 
under an extremely bright light, and from this we recognize 
the fact that the atmosphere is filled with floating particles. 
Some of these are large enough to be seen under a bright 
light, as we have remarked, but by far the larger number are 
invisible except with the aid of a microscope. The character 
and composition of these vary greatly. They may be merely 
floating bits of metal or of vegetable origin ; they may be 
particles emanating from an animal ; they may be decaying 
emanations from the breath ; or they may be independent 
living organisms. 

The discovery of the latter class, called micro-organisms, or 
microbes, has within a few years thrown a flood of light upon 
the practice of medicine and revolutionized the art of surgery. 
Many diseases are now acknowledged to be due to these 
micro-organisms. In consumption, for example, the tubercle 
bacillus — the micro-organism of consumption — finds its way 
into the system through the food or the breath, and wanders 
about until it finds a weak spot where circumstances are 
favorable for its growth. In the more common class of cases, 
this is found in the lungs, and here it establishes its home 
and increases and multiplies until the subject is carried off by 
the disease which it has planted in his system. The micro- 
organism of cholera and of some other diseases have been 
recognized. 

There is another class of micro-organisms which require a 
break in the skin in order to exercise their power. These are 
the microbes which in former days rendered surgical opera- 

87 



55 THE IMPLEMENTS OF REPAIR 

tions so dangerous. An instance of the terrible power of 
some of them was of almost daily occurrence. How often 
has death resulted from the prick of a pen-knife or even the 
scratch of a pin ! And in how many other cases has death 
been averted only by the amputation of a limb which has 
received some apparently insignificant wound. 

Micro-organisms may be introduced into a wound either by 
the instrument making the wound, they may be floated to it 
in the air, or they may be derived from other substances 
coming in contact with it. Finding in a wound a suitable 
soil for its growth, the micro-organism multiplies with incred- 
ible rapidity, and by its presence produces processes of 
decay which result in the formation of poisonous substances 
called ptomaines. The products of the decay set up in a 
wound by micro-organisms are not only irritating to the 
wound itself, producing inflammation and pus, but when 
absorbed into the body cause disease of the entire system. 

The agency of micro-organisms, then, in the production of 
disease, and the contamination of wounds being known, it 
becomes evident that the development of such troubles can 
be avoided (i) by preventing the entrance of micro-organ- 
isms, and (2) by their destruction in case they should be 
present. Upon these premises is founded the modern treat- 
ment of consumption, cholera, and other affections. The 
physician of the present day aims at the destruction of the 
infecting microbe in these cases by flooding the saliva in the 
first case and the excrement in the latter with a solution 
which shall have the power to annihilate the microbes. 
Such a solution is called a germicidal solution, and the agent 
giving rt its power is a germicide or ' ; germ-killer. " 

In surgical operations the surgeon avoids the action of 
micro-organisms in case of a fresh wound by preserving it 
from contact with any gas, fluid, or solid which might taint it. 
In other w T ords, he keeps it scrupulously clean. In case of a 
wound which might have become infected, such as would be 
the case with any one received out of the limits of a properly 
equipped surgical operating-room, or with any instrument not 
previously purified, all possible infection should be avoided 



GERMS, THEIR ACTION AND ITS CONTROL 89 

by bathing it with a germicidal solution which would either 
kill the microbes, or an antiseptic solution which would para- 
lyze and render them harmless. To prevent contagion from 
the atmosphere, surgeons frequently keep a germicidal solution 
constantly flowing over the parts during an entire operation. 

When the time comes for a wound to be dressed, the future 
contact of micro-organisms is prevented by the application of 
a dressing that has itself been made antiseptic. Such dress- 
ings are prepared by filling a clean dressing with a germicide 
in a certain proportion. Cheese-cloth or tarlatan are the 
fabrics most frequently used for this purpose, and when so 
treated are called "antiseptic gauze."* Where a bit of anti- 
septic gauze is available in case of a wound, it is a good plan 
to apply it at once in the absence of a medical man and 
retain it in place until removed by a surgeon. 

In military life, such a dressing is made constantly avail- 
able by the provision of the first-aid dressing-packet issued 
to soldiers. The essential portion of this packet, which is 
fully described in the chapter on dressings and applications, 
is an antiseptic compress which is designed to be applied 
immediately after the wound has been received. 

It must not be inferred that the use of antiseptic agents as 
a protection against micro-organisms insures a good result in 
every case of injury, for such is not the case. Antiseptics 
merely greatly increase the probability of a happy issue, and 
their effect upon microbes may be counteracted by other 
causes. 

As has been remarked, where absolute cleanliness in dress- 
ings and handling of the wound can be had in a fresh wound 
in a healthy person, antiseptics are not necessary. But this 
means surgical cleanliness, which does, not mean the same as 
ordinary cleanliness, for the daintily white linen from my 
lady's linen closet may be a nest of unseen carriers of putre- 
faction. Surgical cleanliness signifies the absence of germ 
life. 

However, where antiseptics are not available, ordinarily 
clean dressings and clean water may be used, since they are 
apt to be surgically clean also. A considerable proportion of 



90 THE IMPLEMENTS OF REPAIR 

cases dressed in this way have done well, and good results 
may be hoped for in the future. But the simpler antiseptic 
agents are so common that occasions will be comparatively 
rare w T hen one of them cannot be obtained. 

Salt. — The ordinary table salt has antiseptic powers, as is 
shown by its prevention of putrefaction in salt pork and other 
meats. A tablespoonful in a pint of water will make an 
excellent solution. 

Sugar also has antiseptic properties, and may be applied to 
the wound as a powder, or it may be made into a very thin 
syrup. 

Vinegar, like salt, has shown its antiseptic powers by its 
action as a preservative. It may be applied to w r ounds in the 
proportion of one part to three or four of water. 

Carbolic acid, a dangerous corrosive poison when taken 
internally, was the first antiseptic agent to be used in sur- 
gery. It should be in small transparent crystals, and used in 
the proportion of two teaspoonfuls to the pint of water. 

Corrosive sublimate, when obtainable, is the most efficient 
germicide we have. It is, however, a most powerful poison, 
and must be greatly diluted when used. In the proportion of 
four grains to the pint of water, however, wounds may be 
bathed by it with perfect security. Corrosive sublimate does 
not dissolve rapidly in cold water, but a solution is quickly 
made by heating the water. 

The destruction of germs by the disinfection of clothing, 
furniture, and houses, and its application to the prevention" 
of the spread of disease, is again considered in the chapter 
on hygiene. 



CHAPTER XIII 

KNOTS AND BANDAGES 

In the application, particularly of extemporized dressings, 
the knowledge of the proper method of tying a knot is of the 
greatest importance. If a bandage be fastened with an inse- 



KNOTS AND BANDAGES 



91 



cure knot, it may slip and cause irreparable damage. Conse- 
quently the consideration of the subjects of knots should not 
be overlooked. 

The False Knot or ' * Granny. ' ' — This knot is described 

only for the purpose of showing what should not be used. It 

( is formed — the ends of the cord or handkerchief being held 

in the two hands — by winding the end held in the right 




Fig. 59. — The false knot in cord. 




-The false knot in I 
kerchief. 



hand over that held in the left, and then, changing hands, 
winding that now held in the right hand over that held in 
the left. In other words, the " granny " knot is tied by simply 
repeating the same movements in making the second turn 
that were made in the first, and for that reason it is the knot 
most commonly tied by those who have not been instructed. 
The Square or Reef Knot. — This knot is very secure when 
tied, so that it may be trusted to hold any kind of appliance 
in place. It is also very easy to untie, a matter of no little 
consequence in removing dressings. This knot should always 
be employed. It is formed — the ends of the cord or hand- 
kerchief being held in the two 
hands — by winding the end held 



Fig. 62. — The reef knot in handkerchief. 




Fig. 61. — The reef knot in cord. 



in the right hand over that held in the left, — in this respect 
being exactly the same as the ^granny"; then winding the 
end now held in the left hand over that held in the right. In 



9 2 



THE IMPLEMENTS OF REPAIR 



other words, the same end of the handkerchief is wound over 
the other in both instances, ' it having changed hands after 
the first turn. 

Other knots which it is useful to know are the surgeon's knot and 
the clove hitch. The surgeon's knot is used by surgeons particularly 
in drawing tissue together, to prevent slipping of the first turn of the 
knot. It is tied simply by turning the right- 
hand end of the cord twice about the left in 
the first turn, and then completing the knot 
as in the ordinary reef knot. It should, not 
be used in tying bandages. 

The clove hitch is used when it is de- 
sired to get a firm hold of a limb in order 
to pull hard upon it, as in setting a dislo- 
cated joint. Its advantage over the ordinary loop is that it will not 
slip and bind the limb so as to stop the current of blood. Its con- 
struction can readily be understood from Fig. 64. The loops thus 
formed being slipped on to a limb, are drawn snugly 
but not so tightly as to constrict it, and then any amount 
of pulling on the two ends will not tighten it. 




Fig. 63. — The surgeon's knot. 




Fig. 64. — The 
clove hitch. 



The triangular bandage presently to be de- 
scribed is always fastened either by the reef 
knot or by pins ; and, in the latter case, the 
safety pin (Fig. 65), used by Esmarch him- 
self, is much the more suitable. 

Bandages are used to support various parts of the body 
when injured ; to bind on and keep in place dressings for 
wounds and splints for broken bones ; to overcome excessive 

muscular action ; to prevent 
disturbance of parts by the 
patient himself; as tempo- 
rary appliances to check 
Fig 65. — The safety pin. bleeding; and for the pro- 

tection of wounds from ex- 
posure to the elements, from insects, and from dirt. 

Unbleached muslin, of a moderately heavy quality, is the 
material usually employed for bandages, although the bleached 
variety, linen, cheese-cloth, cambric, and other similar fabrics 
may be used with full as much satisfaction. Flannel is often 
used where warmth with elasticitv is desired. 



THE TRIANGULAR BANDAGE 



93 



While bandages should be fitted snugly, care should be 
taken not to draw them so tightly as to constrict the limb. 
A tightly drawn bandage may readily cut off the blood supply 
of the parts beyond it. and cause gangrene or death of the 
part. 

Bandages are chiefly of two shapes, the triangular and the 
ribbon-like, or roller bandage. 

The triangular bandage, recommended by Mayor of Lau- 
sanne early in the present century, was introduced to popular 
use by Surgeon-General Esmarch of the Prussian service, 
who, in 1869. caused them to be furnished to the army 
under his supervision, with pictures printed upon them 
(Fig. 66) showing the principal methods of application. 




LOWER BORDER 
Fig. 66. — Esmarch : s triangular bandage. 



Triangular bandages are made by dividing a piece of muslin 
a yard square into halves by a diagonal cut joining two 
opposite corners. This bandage is pre-eminently adapted 
for use on the battle-field and for any emergency. 

These bandages, as issued under the direction of Esmarch, 
are like that shown in the cut, which is a photographic 



94 THE IMPLEMENTS OF REPAIR 

reproduction of one issued by the medical department of the 
United States Army. 1 

The St. John Ambulance Association 2 of England, and the St. 
Andrew's Ambulance Association 3 of Scotland, each issue a pictorial 
triangular bandage. The Scotch bandage is really a remarkable affair, 
with no less than fifty illustrations, covering almost the entire field of first 
aid to the injured in a most clear and minute manner, and accompanied 
by a little book of instructions on its use. 

In the illustration may be seen the creases made bv folding 
the bandage. To fold it. the two ends are folded 'down to 
the point, and the square thus formed is folded in five. 

The shape and size of the triangular bandage may be 
modified in various ways to adapt it to different purposes. 
If smaller triangles are desired, one, half the size of the large 




Fig. 67. — Diagram, showing the points at which the triangular bandage is folded 
for use. AB, CD. Folds for broad cravat. AB, w_r, yz. Folds for narrow 
cravat. 

one, can be formed by folding the two ends together, and 
two may be made by cutting it along the line of the fold. 
Or it may be made into a cravat of varying width by folding 

1 Illustrated triangular bandages can be obtained in this country from any 
dealer in surgical instruments, either direct or through a druggist. 

2 These bandages can be had post free for sixpence each on application to the 
Honorable Director of Stores, St. John's Gate, Clerkenwell, London, E.G., 
England. 

3 The illustrated triangular bandage of the St. Andrew's Ambulance Associa- 
tion can be obtained post free for eight and one-half pence each, from the Secre- 
tary at the Head Office, 93 West Regent Street, Glasgow, Scotland. 



THE TRIANGULAR BANDAGE AS A SLING 95 

it in lines parallel to the lower border. A broad cravat is 
made by folding the point down to the middle of the lower 
border, and then folding this again in the same way ; the 
first fold would then be along the line AB (Fig. 67), and 
the second along the line CD. To form a narrow cravat, 
the first fold would be the same, AB, but there would be two 
secondary folds, wx and yz y instead of one. A twisted cord, 
formed by twisting the narrow cravat, may be used as an 
improvised tourniquet for checking bleeding. 

The triangular bandage is of especial value because of the 
facility with which its uses can be learned and the rapidity 
with which it can be applied, while at the same time it makes 
as good a temporary dressing as may be desired. For this 
reason its use is first to be learned, and unless a high degree 
of proficiency is desired, a familiarity with its applications is 
a sufficient knowledge of bandaging. 

The Triangular Bandage as a Sling. — There are three 
forms in which the triangular bandage may be utilized as a 
sling to support an injured arm. 

1 . The Narrow Ar??i Sling (Fig. 74) is made from either 
the broad or narrow cravat, as desired, and is applied by 
(1) placing one end over the shoulder of the injured side 
and (2) allowing the other end to hang down in front, while 
(3) the injured arm is bent up to the desired height in front 
of it ; (4) the end hanging down is then drawn up in front 
of the arm and over the shoulder of the uninjured side ; 
(5) the ends are drawn up over the shoulders so as to hold 
the arm in the most comfortable position and (6) tied with a 
reef knot behind the neck or over one shoulder. 

2. The Broad Arm Sling" is formed by folding the triangle 
but once — along the line AB (Fig. 67) — and applied in 
the same manner as the narrow arm sling. 

3. The Large Ami Sling may be applied in three different 
ways, according to the extent and character of the injury. 

a. (1) Placing one end (Fig. 68) of an unfolded tri- 
angular bandage over the uninjured shoulder, (2) let it hang 
down in front of the body with the point toward the injured 
side ; (3) draw the point over well beyond the elbow of that 



9 6 



THE IMPLEMENTS OF REPAIR 



side, (4) raise the forearm to the desired level, and (5) lift 
the loose end of the bandage so as to support the arm in that 
position, and (6) pass it over the shoulder of the injured 
side, where (7) it is tied behind the neck or over the shoulder 
with a reef knot ; (8) then the point is brought over in front 
and secured with a safety pin so as to form a rest for the 
elbow. 

b. A second form (Fig. 69) of the large sling is formed 
by passing the loose end of the triangular bandage around 
under the arm of the injured side to the 
back, and tying the two ends there, the 
sling thus passing over the sound shoul- 
der only. This variety is used where 
the shoulder of the 
injured side is so 
tender as not to be 
able to bear any 
weight. 



Fig. 68. — Large arm sling, 
where the shoulder of the 
injured side is unhurt. 



c. A third form 

(Fig. 70) of the Fig. 69.— Large arm sling, 

large arm sling is where the shoulder of 

& *> the injured side is hurt 

the same as the a iso. 





second form, except 

that the sling passes over the shoulder Fig. 70 

of the injured side only, so that the 




- Large arm sling, 
where it is desired not to 
place it over the shou!- 

sound arm can remain tree tor any pur- der of the sound side 
pose that may be required. 

The Triangular Bandage for Wounds. — The mode of 
application varies according to the location and character of 
the injury, and each variety will be considered individually. 

The Top of the Head. — If possible, the patient should be 
seated in a chair. Standing behind him, (1) fold the lower 
border of the bandage under, as if making a hem about two 
inches broad; (2) place the bandage (Fig. 71) with the 



THE TRIANGULAR BANDAGE FOR WOUNDS 97 



middle of the hem just over the nose, and the point of the 

bandage hanging over the back of the head to the neck ; 

(3) bring the two ends back around the head above the 

ears ; (4) cross them ; (5) bring them around to the front 

again, and (6) tie them in a reef knot ; 

then (7) pull the point downward to 

make it fit closely over the head, and 

(8) turn it up on to the top of the head 

(Fig. J2>) an d pin it there. 

The Chin, Ears, or Side of the Face. 

— Using the narrow cravat. (1) place 

the middle under the chin, (2) draw 

the ends upward, and (3) tie them in 

a reef knot on top of the head. 

The Eyes, or Front of the Face. — 

The narrow cravat is folded about the 

head, with the middle at the middle line of the face, and the 

ends tied behind in a reef knot. 

The Neck. — The narrow or broad cravat may be used here, 
as circumstances may indicate, en- 
circ4%ng the neck, and having the 
ends tied on the side opposite to 
the injury. 




Fig. 71. — Triangular band- 
age applied to the head, 
from in front. 




Fig. 72. — Triangular bandage for 
the chest, front view. 



The Chest a?id Back. — (1) 
Apply the triangle (Figs. 72 
and 73) with its centre at 
the middle of the chest and 
the point over the shoulder 
of the affected side ; (2) carry 
the two ends about the body, 
and (3) tie them in a reef knot 




Fig. 73. — Triangular bandage for chest, 
— back view, — shoulder, hand, and 
amputation-stump of arm. 



9 8 



THE IMPLEMENTS OF REPAIR 



at the back, (4) leaving one end considerably longer than 
the other : (5) then draw the point over the shoulder, and 
(6) tie it to the longer end left from the preceding knot. In 
case of injury to the back, reverse the procedure. 

The Ribs. — In case of injury to the ribs, use two broad 
cravats. (1) Place the middle of the upper one over the site 
of injury, if it affect the upper ribs, and well up under the 
armpits ; (2) pass it about the body, and (3) tie in a reef 
knot on the opposite side. (4) Place the other one similarly 
directly below the upper one, and apply it in the same 
manner. 

The Shoulder. — (1) Lay the triangle (Figs. 73 and 74) on 
the shoulder so that the lower border will come down to the 
middle of the upper arm and the point will extend well up on the 
neck ; (2) carry the two ends about 
the arm. (3) cross them on its inner 
face, and tie them in a reef knot on 
the outside ; (4) make a narrow or 
broad arm sling, and (5) draw the 
point under the sling where it passes 
over the affected shoulder. In case 
the shoulder is injured so as not to 
be able to sustain the sling, a small 
cravat bandage passed about the neck 
may be used in its place. 

The Upper Arm. — Using the 
Fig. 74. — Triangular bandage broad cravat, (i) place the middle 
for shoulder, hand, and fore- f the bandage in front of the limb ; 
(2) pass the ends about it, (3) cross- 
ing them behind, and (4) tie them in 
a reef knot in front (Fig. 74) . Support the arm in a sling. 

The Elbow. — Two plans may be adopted : a. (1) Place the 
middle of a narrow cravat on the back of the upper arm, near 
the elbow ; (2) draw the ends to the front ; (3) cross them ; 

(4) pass them back, crossing them at the tip of the elbow ; 

(5) cross them in front of the upper portion of the forearm, 
and (6) pass them around it, (7) tying the ends in a reef knot 
at the back. 




arm, and as a narrow arm 
sling. 



THE TRIANGULAR BANDAGE FOR WOUNDS 99 




Fig. 75. — Triangular bandage, 
as a figure of eight, for the 
hand. 



b. Or pass a broad cravat about the elbow in the same 

manner as in the upper arm (Fig. 74) . 

The For ear 771 mid Wrist. — Apply a broad cravat as in the 

upper arm (Fig. 74), and use a large arm sling. 

The Hci7id. — There are two ways : a. Where it is desired 

to cover the whole hand (Fig. 74), (1) spread a triangle out, 

(2) lay the hand upon it with the wrist on the lower border 

and the fingers toward the point ; (3) fold the point back 

over the fingers, carrying it above the wrist ; (4) pass the 

ends about the wrist, binding down the point ; (5) cross 

them ; (6) bring them back, and 

(7) tie them in a reef knot over 

the point. This method may be 

used with advantage in dressing 

stumps after amputation, as has 

been done on the right arm of 

Fig. 73- 

b. In case of an injury (Fig. 75) 

to the back of the hand, (1) place 

the middle of a narrow cravat across the back of the hand, 

just below the thumb ; (2) bring the ends around the hand, 

crossing them on the palm ; (3) bring the ends over the 
back, (4) crossing them over the 
back ; (5) pass them back about 
the wrist, (6) cross them and (7) 
bring them back, (8) tying them in 
a reef knot on the back of the wrist. 
If the palm is wounded, the pro- 
cedure is simply reversed. This is 
called a figure of eight handker- 
chief bandage ^for the hand, and 
the part should be supported in the 
large arm sling. 

The Hip. — (1) Pass a narrow 
cravat about the body like a belt, 
(2) tying it in a reef knot on the 
side opposite to the injury. (3) Lay 

a triangle upon the hip with its lower border well down on 




Fig. 76. — Triangular bandage 
for the hip. 



IOO 



THE IMPLEMENTS OF REPAIR 




Fig. 77. — Triangular 
bandage for the 
knee. 



the thigh, and the point upward. (4) Pass the ends about 
the thigh, (5) crossing them and (6) tying them in a reef 
knot, or pinning them on the outside ; (7) slip the point 

under the belt, bring it over, and secure it 

with a pin (Fig. 76). 

The Thigh, Knee, and Leg. — The cravat 

is used (Fig. 77) in the same manner as in 

the upper arm. 

7 lie Foot. — (1) Spread a triangle out, 

and (2) place the foot in its centre, with the 

toes directed toward the point ; (3) draw 

the point back over the toes and instep ; 

(4) take the ends and pass 

them about the foot over 

the tip, (5) crossing them 

on the instep ; (6) again 

in the sole of the foot, and 
(7) bringing them back, (8) tie them in a 
reef knot over the instep (Fig. 78). 

The Square Bandage. — A handkerchief a yard Fig 78 —Triangular 
square makes a covering for the entire head and bandage for the 

neck, excepting the face, and makes a very efficient foot, 

protection. The handkerchief is so folded that the 

under layer projects about four inches 
beyond the upper. The long rectangle 
thus produced is laid upon the head so 
that its middle rests upon the middle line 
of the cranium, while the margin of the 
longer flap falls down to the tip of the 
nose, and that of 
the upper to the 
eyebrows, the 
short borders 
hanging upon the 
shoulders. Of the 
four corners hang- 
ing down upon 
the chest in front, 
the two outer ones 

are first tied firmly under the chin. The border Fig. 80. — Large square 
of the under fold is then turned upward against handkerchief applied. 





Fig. 79. — Large square hand 
kerchief for the head. Pre 
li mi nary stage. 






THE ROLLER BANDAGE IOI 

the forehead, and the two inner corners belonging to it are pulled for- 
ward from under the upper borders and carried to the back of the head, 
where they are tied in a reef knot. 

The Four-tailed Cap. — A handkerchief three-quarters of a yard long 
and a quarter of a yard wide, and slit up for a considerable distance at 
the narrow ends, forms 
a most excellent cover- 
ing for the head, and 
support for surgical 
dressings there. If it 
is desired to apply it to 
the top of the head, it 
is placed thereon, and 

the two front tails tied ._■ 01 T , , . .._. ... . T1 _ , . ., , 

Fig. 81. — The four-tailed Fig. 82. — The four- tailed 

at the back of the head, cap for the top of the cap for the back of the 

and the back tails un- head. head. 

der the chin. If the 

back of the head is to be covered, the front corners are tied under the 

chin, and the two back ones over the forehead. 

The Four-tailed Bandage. — A bandage three inches wide and thirty 

to seventy inches long, is slit from both its ends, leaving a space three 

inches long in the centre, producing four tails of equal length. A little 

slit is also made in the middle of the centre piece. If the bandage is 

short, the centre piece is applied to the chin, and the upper tails are 

carried behind the neck and tied in a reef knot, while the lower tails 

are similarly carried up and tied on the top of the head. 

The Roller Bandage. — The roller bandage is a ribbon-like 
strip of varying material, prepared for binding about disabled 
parts of the body, and when not in use is rolled up into a 
cylinder. 

The proper application of the roller bandage requires con- 
siderable practice and experience in order not only to apply 
it so as to appear smooth and even, but also to avoid unequal 
pressure, by some folds being drawn tighter than others, the 
entire bandage being drawn tight enough to prevent slipping, 
and loose enough not to strangle the part, from which great 
harm — extending even to the death and decay of the limb — 
may result. For this reason these bandages are better adapted 
to the trained hand of the physician and nurse. The triangu- 
lar bandage is better adapted to the non-professional hand. 
and for that reason greater prominence has been given it in 
this work. 



102 



THE IMPLEMENTS OF REPAIR 






Roller bandages may be elastic, semi-elastic, or inelastic, according 
to the material composing them. India rubber is the chief constituent 
of the elastic bandages, which are used to check the flow of blood — 
when drawn tightly enough to cut off the circulation in a part, and, when 
so applied as to exert gentle pressure, are of value in the treatment of 
enlarged veins and the ulcers resulting from them. Semi-elastic band- 
ages are made of flannel, silk net, or other materials possessing a 
certain amount of elasticity. They are easier to apply than the inelastic, 
for they can be simply rolled on without reversing. 

Inelastic roller bandages, like triangular bandages, are usually made 
from a nfedium-weight unbleached muslin, although cheese cloth, 
bleached muslin, linen, cambric, and other similar fabrics may be used 
when necessary. Tarlatan and mosquito netting are used where the 
bandage is to be impregnated with a stiffening material. 

The inelastic bandage is the most generally useful, and is far less 
expensive than the other varieties. 

Bandages should not be cut, but torn, where the texture is of sufficient 
firmness to permit. And in any case the selvage should be torn from 
the edge, since it renders the margin less yielding than the remainder 
of the bandage, and is liable to produce unequal pressure. 

The sizes most convenient for use vary both in width and length, 
according to the locality in which they are to be employed. The follow- 
ing table will indicate that of the more commonly used : — 

Bandage for the Head, 2 to 25 inches wide and 5 to 7 yards long. 



" Finger, 5 

" Hand, 1 inch 


' " 1 to 2 

" 4 to 5 


" Arm, 15 to t.\ ," 
" Shoulder, t.\ " 


' " 8 to 12 
1 " 8 to 12 


" Chest, 3 to 4 " 


1 " 6 to 8 


" Leg, 2 i 
" " Foot, 2^ " 


' " 10 to 12 
' " 4 



The roller bandage can only be conveniently applied after the strip 
has been rolled into a close, compact cylinder. The simplest and 
quickest way to form a strip into the cylinder is (1) to turn in one end 
of the bandage sufficiently to start a roll ; (2) to place the bandage upon 
the thigh, with the partial roll near the groin, and the strip extending 
down on the thigh to the knee ; (3) beginning with the tips of the 
fingers, roll the cylinder, already begun, between the hand and the thigh 
until the roll reaches the wrist; (4) draw the bandage up the thigh with 
the partly completed roll just below the groin, and repeat the manoeuvre 
until the entire bandage is rolled. 

A bandage may be rolled by turning the roll between the thumb at 
one end and the fingers at the other end, but the method is so slow as 
to be much less desirable than that given above. 



THE ROLLER BANDAGE 



IO3 



Points to be observed in applying Roller Bandages in general: — 

1. Begin at the lower end of a limb. 

2. Avoid binding the limb too tightly or leaving the bandage too 
loose. 

3. Leave the tips of the fingers or 
toes uncovered, so that they can be 
easily examined to see whether the 
bandage is too tight or not. If they 
are cold and blue, it should be loos- 
ened at once. 

4. Apply the bandage smoothly, 
leaving no wrinkles. 

5. Avoid unequal pressure, taking 
care that the turns of the bandage are 
applied with equal force, and that one 
edge is not tighter than the other. 

6. Avoid reversing a bandage over 
a sharp bone; make reverses on the 
fleshy side of a limb. 

7. Bandage a limb in the position 
in which it is to be retained ; bandag- 
ing a limb straight, and then bending 
it, will bind it too tightly ; and if a 
limb be bandaged, bent, and then 



Fig. 83. — Rolling a roller bandage. 





Fig. 84. — Roller bandage arm sling. 



straightened, the bandage will 
be too loose. 

8. A bandage should not be 
applied wet, for it will shrink 
upon drying, and bind the limb 
too tightly. 

The Roller Bandage Arm 
Sling. — (1) Raise the forearm 
to the height desired; (2) pass 
a three or four inch bandage 
about the forearm, just below 
the elbow ; (3) then pass both 
ends around the neck ; (4) bring 
the long end down under the 
wrist or hand, and (5) pass it 
up to the neck and tie it to the 



104 



THE IMPLEMENTS OF REPAIR 




Fig. 85. —The circular and rapid spiral "turns. 



short end. The arm is now swung in a double sling, being supported 

at the forearm and at the hand or wrist. 

The Circular Turn. — In this turn the bandage passes directly about 

a limb, all the turns 
being upon the same 
level. A soldier's belt 
is a circular bandage 
of the abdomen. 

The Spiral Turn. 
— In these turns the 
bandage is placed a't 
an angle so that they 

encircle a limb in a spiral direction. There are two varieties of the 

spiral turn. 

(a) The rapidly ascending spiral (Fig. 85) 
passes up the linib without its edges overlapping, 
and is used for holding dressings in place. 

(b) The slowly ascending spiral (Fig. 86) 
passes up a limb, with the lower edge of each 
turn overlapping the upper edge of the preced- 
ing. This turn is applicable only where a limb 
is of uniform thickness, as often occurs in the 
upper arm. 

The Reversing Spiral Turn. — This is a modi- 
fication adapted to limbs which increase or di- 
minish in size, and is designed to avoid the 
gaping of the turns which would occur with a 
simple spiral. Its application, clearly shown in 
Fig. 87, consists in simply turning the bandage 
over forward so that its upper margin will be 
below when the point of separation of two turns 
is reached, — repeating the manoeuvre whenever 
necessary to prevent gaping. 

The Figure of Eight Turn (Figs. 75 and 88). 
— This turn owes its name to the fact that it brings the bandage into 
the form of the numeral 8. In the hand it is formed (1) by placing 




Fig. 86. — The slow 
spiral turn. 




-The three steps taken in applying the reversing spiral tu 



THE ROLLER BANDAGE 



I05 




8. — Figure-of-eight turn applied to the 
hand. 



the end of the bandage at the palmar face of the wrist ; (2) bringing it 
across the back of the hand and below the thumb, and (3) across the 
palm at the root of the 
fingers ; then (4) up and 
across the back to the 
wrist; (5) across the pal- 
mar face of the wrist; 
then (6) up and across 
the back, over the first 
turn ; (7) repeating these 
manoeuvres as many 
times as it may be de- 
sired to fold the band- 
age about the hand, and (8) finally securing it with a circular turn about 
the wrist. 

The figure-of-eight turn is employed especially where the bandage 
needs to pass over a joint. 

The Spica Turn (Fig. 89). — This is a figure of eight with one loop 

very much larger than the other, and is 

employed at the function of a limb with 

the body, as at the 

shoulder and the hip. 

Its mode of applica- 
tion is exactly similar 

to the figure of eight. 
To bandage the 

Whole Upper Ex- 
tremity (Fig. 89). — 

To secure technical 

correctness, every 

digit and the entire 

hand should be 

bandaged with a 

narrow roller, as 

shown in Fig. 89. 

As a matter of fact 

this is rarely done, 
on account of the length of time required for it. 
The more common method is, (1) placing layers 
of cotton between the fingers and a larger mass Rg 90 _ RoMer bandage 
in the palm ; (2) to begin with the arm bandage of the who)e )ower ex _ 
at the tips of the fingers, and carry it up to the tremity. 
wrist by figure-of-eight turns, leaving the thumb 

out; (3) the forearm is then bandaged by a reversing spiral, (4) the 
elbow by a figure of eight, (5) the arm by an ascending spiral, and. 
(6) the shoulder by a spica. 




- Roller bandage of 
vhole upper extremity. 




io6 



THE IMPLEMENTS OF REPAIR 




Fig. 91. — The knotted 
turn. 



To bandage the Whole Lower Extremity (Fig. 90). — (1) Catch the 
bandage by a turn or two about the toes, then (2) cover the foot by a 
narrow figure-of-eight turn ; (3) bandage the leg with a reversing spiral, 
(4) the knee by a figure of eight, (5) the hip by a spica, (6) which is 
completed by a few circular turns about the belly. 

The Double-headed Roller. — This is the roller bandage rolled from 
both ends to the middle. It is used for amputation stumps, and for 
drawing together the edges of wounds, but is 
especially employed for the head. 

The Knotted Turn (Fig. 91), used especially to 
control bleeding from the temples, is formed by 
a double head, where turns — one perpendicular 
under the chin, and the other horizontal about 
the brow — are crossed at right angles upon the 
wound, and tightly drawn, as in tying up a parcel. 
A compress is thus held upon the wound under 
the knot. 

The Capelline Turn (Fig. 92) is formed by a 
double-headed roller, one end of which passes 
around the head horizontally just above the ears, and fixes the turns 
of the other, which is carried alternately over the right and left side of 
the scalp, each turn overlapping the preceding one, so as to form a 
skull cap when complete. 

There are a number of other special turns of the roller bandage used 
to protect and support various parts of the body, 
and of the head in particular, but it is believed 
that those enumerated here will suffice to meet 
any emergency. 

To secure the Ends of Bandages. — Roller 
bandages are best secured with needle and 
thread : in default of that, with a safety pin ; 
and in the absence of both, with an ordinary 
pin. Where neither pins nor needles are avail- 
able, the end of the bandage should be split by 
a tear long enough to encircle the limb ; tie the 
two ends at the end of the slit with the first 

motion of a knot, then pass them about the limb in opposite directions, 
drawing the bandage firmly, and tie them in a reef knot. 

Bandages filled with Hardening Material are often applied where 
it is desired to render a limb immovable. These bandages are made of 
light, open-meshed material, such as gauze, tarlatan, crinoline, and 
mosquito netting. Plaster of Paris is the most common material used 
for filling these bandages ; but starch and water-glass are also used for 
the purpose. 




Fig. 92. — The capelline 
turn. 



DRESSINGS AND APPLICATIONS 10/ 

CHAPTER XIV 
DRESSINGS AND APPLICATIONS 

A dressing is a material applied to a wound both to pro- 
tect it and to assist the healing process. It absorbs dis- 
charges and stands guard against dirt and micro-organisms 
seeking admission. 

There are certain features of the dressings of wounds which 
are common to all varieties and which should consequently 
be considered before entering upon the discussion of indi- 
vidual injuries. Special dressings suited for particular injuries 
will be considered in connection with wounds, bleeding, and 
broken bones. 

A wound having been prepared for dressing, it is customary 
to place upon it a mass of soft substance called a compress. 
Compresses may be made of various substances, the condi- 
tions demanded being that they are soft and unirritating, and 
are both generally and surgically clean — free from both 
dirt and germs. The materials most commonly used for this 
purpose by surgeons are cheese-cloth and tarlatan, and from 
these is prepared the modern surgical dressing, antiseptic 
gauze, made by impregnating these materials with a germi- 
cide. In this case, the fabric is folded into many layers, so 
that a sheet of the gauze has considerable thickness. Rolls 
of antiseptic gauze already prepared and put up in tin boxes, 
so as to avoid contact with the deteriorating action of the 
atmosphere, may be purchased in the apothecary shops, and 
should be present in every first-aid dressing-case. In using 
this material, the compress should be cut from the sheet, using 
the entire thickness. 

Other materials useful for compresses are absorbent cotton, 
prepared from ordinary cotton by removing its oily constitu- 
ents ; absorbent cotton may be made antiseptic like gauze, 
and is often thus used in antiseptic surgery. Lint, prepared 
by scraping clean old linen, and charpie, prepared by ravelling 



io8 



THE IMPLEMENTS OF REPAIR 



old linen and cutting up the resulting mass, have been very 
popular as wound dressings, although they are now practically 
disused. Oakum, formed by separating the strands of tarred 
rope, has been prominently in vogue, on account of the slight 
antiseptic quality imparted to it by the tar. It is rather harsh 
for a direct application to a wound, but the finer quality of 
oakum, called marine lint, is comparatively free from this 
objection. Linen worn soft and thin is an excellent wound 
dressing, provided that it is clean, both practically and sur- 
gically. Clean tissue paper makes an excellent application, 
and is often available in the form of toilet paper ; it is much 
preferable as a dressing to handkerchiefs that have been used, 
and to bits of clothing that have been worn, for it is likely to 
be entirely free from germs. Clean printed paper crumpled 
into a mass and softened by clean water is not at all objec- 
tionable, and is vastly superior to soiled clothing. The iron 
in the ink rather adds to than detracts from its usefulness. 

The shape and size of a compress varies according to the 
size, shape, and location of the wound it is to cover. It 
should never fail to be from a quarter of an inch to an inch 
in thickness — better too thick than too thin. It should 
overlap the wound in every direction by at least an inch, and, 
as before, it had better be too much than not enough. Sur- 
gical dressings are either wet or dry. Dry dressings are 
used where the direct application to the wound is a powder, 
but the wet dressings are much the more common and had 
better be used while awaiting a medical man. Where sugar, 
salt, vinegar, or, better, corrosive sublimate is present, anti- 
septic solutions, as described on page 90, can always be manu- 
factured for wetting dressings, and should always be used. 
In the rare cases where none of these can be obtained, or 
where antiseptic gauze is available, clean water may be used. 

Protective applications are used to cover and protect injured 
parts on one hand, and to protect the clothing from being 
soiled on the other. Sir Joseph Lister, the father of anti- 
septic surgery, was accustomed to apply a bit of gutta-percha 
tissue directly over his wounds to protect them from the 
irritating effects of his dressings. Where wet dressings are 



DRESSING FOR WOUNDS 



IO9 



used, it is well to cover them with oiled silk or oiled muslin, 
which not only avoids soiling the clothing, but also prevents 
the evaporation of moisture. 

The First-Dressing Packet, — There are many occupa- 
tions in which men are daily exposed to injuries. In times 
of peace, accidents are of frequent occurrence in large manu- 
factories, sailors of the navy and more particularly in the 
merchant marine, workers in mines, railroad operatives, 
and many others are continually incurring considerable 
risk of injuries : in war times, perhaps, soldiers are in even 
greater danger : and. such is the perversity of inanimate 
things, accidents are most likely to occur when it is particu- 
larly difficult to obtain suitable dressing materials. This is 




Fig. 93. — The frst- dressing packet. 

especially true in the military service, where, if an engage- 
ment be not fought in an inaccessible locality, the number of 
injuries is so great as to make it exceedingly difficult to 
provide proper dressings for all. 

For this reason, an attempt has been made by the military 
authorities to guard against such emergencies by having 



HO THE IMPLEMENTS OF REPAIR 

every soldier carry with him the dressing materials for his 
own possible injuries. This is the first-dressing packet, the 
one issued to the Hospital Corps of the U. S. Army, being a 
flat, flexible package (Fig. 93), about four inches square, and 
from three quarters to seven eighths of an inch thick, con- 
taining all the necessary materials for an emergency dressing, 
wrapped in a piece of gutta-percha cloth nine inches square. 
Upon the cover is printed a list of its contents and some 
brief directions for its use, viz. : — 

Esmarclfs First Help for Wounds 

Contents of Package 

2 antiseptic compresses of sublimated gauze in oiled paper. 
1 antiseptic bandage of sublimated cambric, with safety pin. 
1 Es?nar ch^s triangular bandage, with safety pin ; mode of appli- 
cation illustrated on same. 



Directions 

Place one of the compresses on the wound, removing the oiled paper. 
In cases of large wounds open the compress and cover the whole 
wound. Apply the antiseptic bandage over the compress. Then ttse 
the triangular bandage as shown by illustrations on the same. 

The antiseptic compresses are cheese-cloth roller bandages, 
a yard long and three and a half inches wide, folded to two 
inches wide and three and a half long ; the antiseptic band- 
age is a roller two yards long and four inches wide, and both 
'are impregnated with corrosive sublimate, the most efficient 
germicide known to science. The oiled papers in which the 
compresses are wrapped serve to protect them from any 
external influences which may penetrate through the outer 
covering, and keep them from all possible contamination, and 
as well as the gutta-percha cloth cover itself can be used as a 
protective. 

In case of a wound by a rifle ball passing through any part 
of the body, the two compresses should be applied, one at 
the entrance and one at the exit of the ball. In case of a 



THE FIRST-DRESSING PACKET III 

single large wound, the two may be combined, and by unfold- 
ing and refolding into another form they may be made to 
cover a wound ten or twelve inches long and three inches 
wide, or eight inches long and six inches wide. This would 
protect a shell wound of considerable size, while almost any 
sword cut that might be received could be dressed by it. 
The oiled papers should be bound over the compresses with 
the antiseptic bandage and secured with the safety pin. The 
whole wounded part may then be covered with the triangular 
bandage after the manner described in the chapter on knots 
and bandages, or that portion of the dressing may be used 
as a bandage to bind on a splint in case a bone has been 
injured, as a tourniquet to check bleeding in case of a 
wounded artery, or as a sling in case of an injury of an arm. 



The first-dressing packet of the British army consists of two com- 
presses of tow impregnated with wood tar to which ten per cent of 
carbolic acid has been added, each measuring dry four by five inches 
and one eighth of an inch in thickness ; a carbolized gauze roller 
bandage four inches wide and two yards long, with a safety pin ; and 
a triangular bandage without illustrations, folded and fastened together 
by four common pins. These are wrapped in a piece of tin foil seven 
and one half by ten inches, and then in parchment paper which is 
pasted together by sublimate paste ; on the paper cover are printed 
also the directions for using the contents. 

In the German and British armies, every soldier carries one of these 
packets in some specified portion of his clothing. The German carries 
it stitched, in some branches of the service, in his trousers, and in 
others, in his coat skirts ; in the Soudan expedition the British carried 
them in their breast pockets. The place where the packet is carried 
is not of so much consequence as that it should always be the same, so 
that when required for use it can be found at once. The German plan 
of stitching it into the clothing so that it cannot be removed is an 
excellent one and prevents its loss. 

The value of these packets has been conclusively demonstrated in 
actual warfare. At Tel-el-Kebir, after the Egyptians had been driven 
from their position, and the wounded of the British forces were still 
lying near their works, the dressings from the packets were applied in 
numerous instances with great benefit, either by the wounded men 
themselves, by their comrades, or by sanitary soldiers. In many cases 
it was done so satisfactorily that the surgeons found no further dressings 
necessary until the men were removed to the hospital. 



112 THE IMPLEMENTS OF REPAIR 

The use of the packet as an immediate dressing insures for 
wounds a temporary treatment which will prevent the inroads 
of micro-organisms, and, as well, protect the parts from heat 
and cold, insects and dirt, until they can receive proper 
treatment. In this way are avoided erysipelas, gangrene, and 
other diseases resulting from neglect of the prompt treatment 
of wounds, while in many instances loss of limb, and even of 
life, is prevented. 

Fixative applications are used both to hold the lips of 
wounds together and to retain dressings in place. The 
suture of silk or catgut with which a surgeon stitches a wound 
together is a fixative, and so is the bandage with which the 
dressings are bound upon the wound. Adhesive plaster is 
used for the latter purpose, but on account of the difficulty of 
keeping clean wounds that have been treated with it, it should 
never be applied to fresh wounds. They should rather be 
dressed with a compress and so retained until a surgeon can 
close them with sutures. The use of adhesive plaster in 
connection with wounds, then, is mainly confined to fixing 
dressings in place. Court plaster may be used for closing 
slight cuts of the skin resulting from ordinary household 
accidents. It is best, however, not to dampen the court 
plaster with the tongue, but with a little pure water, because 
the saliva is filled with micro-organisms, some of which may 
produce serious trouble in the wound. 

Emollient applications are bland substances, either fatty 
or not, which, when applied to sore and inflamed surfaces, 
exert a soothing influence upon them. Such are the petro- 
leum oils sold under the name of vaseline, cosmoline. petro- 
latum, and the like. Sweet, unsalted lard and butter, and oils 
of various kinds, are included under this head. They are 
also of use as applications to the surfaces about wounds, to 
prevent the dressings sticking. These ointments are often 
impregnated with antiseptics, so that they make an antiseptic 
application in themselves and, when covered with a suitable 
compress, make a very useful dressing. Carbolic acid is the 
antiseptic substance most commonly used for this purpose, 
and carbolized vaseline, cosmoline, and the like can be bought 
in the shops.- 



POULTICES 113 

Poultices are emollients of sufficient importance to be 
considered by themselves. They are applied for the purpose 
of giving and maintaining in a part heat and moisture ; they 
are soothing and allay pain ; they assist the formation of 
matter in boils and abscesses ; they draw the blood to the 
surface, relieving congestion of deep parts, and they absorb 
foul secretions and loosen sloughing matter from septic 
wounds. They are easily infected with micro-organisms, and 
should on that account, when used in connection with open 
sores or old wounds, be made antiseptic by the addition of 
some suitable germicide. Corrosive sublimate is not admissi- 
ble here, but carbolic acid may be added in the proportion of 
a couple of teaspoonfuls to the pint of water, and powdered 
boracic acid and charcoal may be dusted over the face of the 
sore and over the surface of the poultice. 

Any material which satisfies the requisite of retaining 
warmth and moisture may be used for a poultice. A com- 
press of Iceland moss soaked for an instant in boiling water 
makes an excellent poultice. These compresses are sold in 
the shops as the "Poultice Instantaneous. 1 ' Linseed meal 
is the material generally used by medical men, but other 
materials, such as bread crumbs, oatmeal, starch, corn meal, 
and bran may be used. 

In order to prevent the escape of heat and moisture, a poul- 
tice should be covered in with oiled silk or muslin, or a layer 
of cotton wadding. They are very apt to stick unpleasantly 
to the parts after being worn for some time, and this may be 
prevented by covering the under surface with some thin 
material such as mosquito netting, or by smearing the part 
with oil or vaseline before applying the poultice. A poultice 
should be as hot as can be borne by the patient, remember- 
ing that children's skin is more sensitive than adults', and 
some adults' more than others' ; testing it by laying it upon 
the Hback of the hand, or by holding it close to the cheek, is 
usually sufficient. Poultices cool after an hour or two and 
should be renewed at least as often as once in two hours 
to secure the best result. The poulticed part should never be 
left uncovered, but a new poultice should always be on hand 
to replace one when it is taken away. 



114 THE IMPLEMENTS OF REPAIR 

Linseed-vieal Poultices require for their manufacture (i) a 
small dish, (2) heat sufficient to boil water, (3) a table-knife, 
(4) a piece of muslin or flannel two or three inches larger 
each way than the desired poultice, (5) a piece of oiled silk 
or muslin of the same size, (6) a piece of thin cheese-cloth, 
tarlatan, or, better than either, mosquito netting, (7) sufficient 
linseed meal, and (8) boiling water. The poultice is then 
made by first scalding out the dish, then pouring in the boil-* 
ing water — which should be kept boiling — and adding lin- 
seed meal little by little, stirring the mixture all the time, 
until it has the consistence of a thick paste. When the 
ingredients are thoroughly mixed, take a table-knife, and, pre- 
viously dipping it into boiling water so that the poultice will 
not stick to it, spread the poultice about half an inch thick 
upon the muslin, which has been evenly laid upon the oiled 
silk ; then lay the thin fabric over its face and neatly turn in 
the margins of the muslin and oiled silk to prevent the 
poultice spreading, and — first testing it to make sure that 
while as hot as it can be borne, it is not hot enough to be 
painful — apply it as needed. 

Oatmeal and Corn-meal Poultices are made in the same manner as 
those of linseed meal. 

Bread Poultices are made by boiling down some stale bread with 
water for five minutes, then draining off the water and spreading the 
bread on the muslin ; then treating it the same as a linseed-meal poul- 
tice, except that its inner face should always be smeared with oil or 
vaseline before applying it. An objection to a bread poultice is its 
liability to become sour. 

Starch Poultices are prepared by first making a stiff paste with cold 
water, then adding boiling water to give it the required degree of 
warmth. All the foregoing are spread and applied in the same manner 
as the linseed-meal poultice. 

Bran Poultices are prepared by first making a flannel bag of the 
desired size, and then, after scalding the bran in a basin, putting it into the 
bag, the open end of which should be quickly sewed or pinned together; 
the bag with its contents should then be quickly wrung out in a towel 
and applied like a linseed-meal poultice. 

Hot Moist Fomentations form another means of applying 
warmth and moisture to painful parts ; they are more quickly 



HOT FOMENTATIONS I I 5 

made than poultices and may be applied where quick action 
is desired. They form a useful application in sprains, and 
headache may often be relieved by laying them upon the 
brow, while the rapidity with which they may be made ready 
renders them peculiarly useful as an application to the belly 
in colic. The ^fomentations usually consist of flannel cloths 
wrung out in hot water. The best way to prepare them is to 
crumple the flannel into a wad and roll it up into the middle 
of a towel, then dip the middle of the towel with the flannel 
into hot water and wring it out well by twisting the ends of 
the towel in opposite directions, touching only the dry ends 
of the towel. The fomentation should be taken to the 
patient before it is removed from the towel, and, with pre- 
cautions not to have it too hot, duly applied, the loss of heat 
and moisture being prevented by a covering of oiled silk or 
cotton wadding. They should be renewed as often as cooling 
shows it to be necessary. The action of the fomentations 
is said to be assisted by the addition of two or three table- 
spoonfuls of turpentine to the water. 

Hot Dry Fomentations are applied whenever there is a 
lack of heat in the system, or in any part of it. The most 
common method of application is by means of hot-water bags 
of india rubber. However, in their absence, flannel bags 
filled with salt, bran, or sand, and thoroughly heated, may be 
used with great advantage. Where the heat is needed very 
quickly, ordinary bottles filled with hot water and tightly 
corked are an excellent substitute. Heated bricks, frag- 
ments of rock, flatirons, and many similar articles, when 
carefully wrapped in flannel or a bit of blanket, have been 
used for this purpose. The chill following great loss of 
blood, the coldness following an escape from drowning, the 
lack of warmth accompanying extreme prostration from 
many conditions, are all to be treated by dry fomentations. 
In these cases, the heated articles should be wrapped in 
cloths and laid in contact with the feet and along the side 
of the body, care being taken not to have them too hot, for in 
partially unconscious conditions the patient might be burned 
without having the power to move away. 



Il6 THE IMPLEMENTS OF REPAIR 

Counter-irritants are commonly used as a relief to pain. 
They are useful in colic, muscular rheumatism, and other 
painful affections, and should be used as a rule under the 
direction of a physician. 

The Mustard Plaster is perhaps the most common form in 
which counter-irritation is applied. The dry mustard should 
be mitigated by mixing with an amount of flour varying 
according to the effect desired, and stirred up with water, or 
preferably the white of an egg. This mixture is then spread 
upon a bit of flannel or muslin and laid upon the skin ; if the 
skin be very sensitive, however, it may be desirable to lay a 
layer of some thin material over its face. The plaster should 
not be kept on too long, or it will form a blister instead of 
merely reddening the skin, as is desired. Fifteen minutes is 
usually long enough. 

The Spice Plaster forms an agreeable and gentle counter-irritant, 
and is made by using a mixture of ordinary cooking spices with the 
white of an egg, in the same manner as a mustard plaster. This is 
particularly useful in children and persons with a very delicate skin. 

The Mustai'd Poultice combines the good qualities of a poultice and 
a counter-irritant, and is a particularly excellent way to apply counter- 
irritation where deep-seated parts are to be affected. It is prepared by 
mixing mustard thoroughly with warm — not hot — water, making from 
a tablespoonful to half the bulk of the proposed poultice, according to 
the strength desired. Then, having made a linseed-meal poultice as 
already described, mix the mustard into it before spreading, and pro- 
ceed as in a simple poultice. 



Part III 

EMERGENCIES AND ACCIDENTS 



CHAPTER XV 
HOW TO ACT AT FIRST 

In the presence of an accident or other emergency, the 
first requisite is presence of mind. The slang expression, 
keep cool, is the first precept to be impressed upon the mind. 
Nothing is more fraught with danger to a person suffering 
from the depressing shock of a severe accident than the noise 
and excitement of an officious bystander ; nothing, on the 
contrary, is more soothing and satisfying to such an one 
than a quiet, collected demeanor upon the part of those 
assisting him. A knowledge of the proper course to pursue 
in such cases will contribute largely toward investing one 
with the proper manner, but it is necessary, particularly for 
those of a more or less excitable temperament, to practise 
curbing the nerves, and to restrain themselves by the knowl- 
edge that a hasty act may precipitate most unhappy results. 

But while excitement and haste are to be condemned, 
promptness coupled with quiet cannot be too earnestly sought. 
In many instances, the ready appreciation of the emergency, 
followed immediately by the application of the proper treat- 
ment, has been the means of saving a life to which a moment's 
delay would have been fatal. But rapidity must be distin- 
guished from haste, and quick movements from excitement. 
The patient should never be able to read the danger of his 
condition from the countenance of his helper. 

And while applying quietly and quickly whatever means of 
assistance he may be able to contribute, the helper must 
remember that his services are but temporary and only to 
tide over the time until educated assistance can be brought. 
Then, if it has not already been done, on coming into the 
presence of a medical or surgical emergency, send for a 
doctor inimediately ! The great danger of instruction in 

119 



120 EMERGENCIES AND ACCIDENTS 

methods of meeting emergencies is the tendency developed 
in some students to feel that they have mastered the healing 
art, and worse, to act in accordance with their feeling. The 
work of the layman instructed in first aid should be restricted 
strictly to the interval between his arrival and that of a 
qualified medical man. A step beyond this is a piece of 
presumption that might readily result in permanent damage, 
if not a fatal result to the patient. 

The reason for the morbid curiosity which induces people 
to crowd about an injured person is difficult to discover. It 
may be a characteristic not eliminated in the evolution of 
man from the monkey. Even cattle and horses crowd about 
an injured one of their kind. It is not uncommon to see a 
person disabled on the street surrounded by a dense over- 
arching wall of humanity, cutting off his supply of fresh air 
and polluting with the breath the small amount that he can 
obtain. The impropriety of this is evident ; then always 
keep crowds back and give the patient an abundance of 
fresh air. On no account should a patient be annoyed by 
miscellaneous questioning, and certainly not by unnecessary 
handling or moving, which might, by reopening a wound or 
displacing a broken bone, cause serious injuries and even the 
death of the patient. 

In many cases the course of action to be pursued in an 
emergency will be suggested by circumstances, especially to 
one who has made a study of the subject. Where no imme- 
diate action seems to be necessary, the patient should be 
placed in as comfortable a position as possible until the med- 
ical attendant summoned can arrive. 

On finding a person who has been injured, particularly if 
he be unconscious, the individual himself and his surround- 
ings should be observed with great care, since the case may 
come into the courts, where such evidence has been of vital 
importance. The location of the person with regard to sur- 
rounding objects should be observed, his relation to neighbor- 
ing dwellings and the possibility of his having fallen from an 
elevated point, such as a window or roof. Any articles lying 
near by should be noted with a view to the possibility of their 



HOW TO ACT AT FIRST 12 1 

having been used as missiles or weapons. A whiskey flask 
near by would suggest intoxication : a bottle labelled lauda- 
num would create a suspicion of opium poisoning : a recently 
discharged pistol would cause a shot wound to be suspected. 
and a bloody knife would be suggestive of stabbing : while a 
riderless horse or a fallen ladder would make one think of 
injuries consecutive to a fall. The appearance of the ground 
surrounding should be examined to see whether it bears 
traces of having been trampled upon as in a scuffle or not. 

The patient himself should be observed with great care — 
even his attitude may tell an important story. His clothing. 
if torn or cut, or soiled with blood, may be a valuable link in 
future evidence: and the location of his injuries, if there be 
any. should be noticed, as well as their relation to surround- 
ing objects. All this should be taken in by a rapid survey 
immediately upon arriving upon the scene, and should not 
interfere with rendering the victim immediate assistance. 

A sick or injured person should always be made to lie 
down on his back if the character of his injuries does not 
forbid, with his lower extremities extended and his arms by 
his side. If he seems faint, his head should be rather lower 
than his feet : if faintness is not present, the head may be 
raised a little and turned rather to one side. Xausea and 
vomiting are very apt to accompany emergency attacks, and 
the probability of this occurring should always be considered. 
If the patient be insensible, he should be watched carefully. 
and in case of nausea, turned to one side, so that the vomited 
matter can be thrown out of his mouth : if he is left upon his 
back, it will be likely to fall back into the windpipe and cause 
fatal choking. If he be conscious, he will the more easily be 
cared for. 

All tight articles of clothing should be loosened to prevent 
interference with breathing or the circulation. Belts and 
collars in particular need attention. 

The popular idea of relief to the injured seems to begin 
with the administration of stimulants. This is an incorrect 
and dangerous notion : for while there are but few cases in 
which stimulants are of benefit, there are manv in which 



122 



EMERGENCIES AND ACCIDENTS 



they are injurious. Where there has been any bleeding, 
stimulants are liable to cause recurrence with all the dangers 
attendant upon it. In case of thirst, water is the best bever- 
age — cold in summer and warm in winter. Warm water 
being distasteful to most persons, it may be administered in 
the form of tea or coffee or broth — they are vastly superior 
to alcoholic drinks. While there are a few conditions in 
which brandy or whiskey or wine may be given with advan- 
tage, they are comparatively so few, and subject to so many 
modifications, that such beverages should never be admin- 
istered except under the direction of a physician. 

In case of a person who is unconscious, or so weak as not 
to be able to give an account of himself, after meeting such 
indications as are conspicuous, he should be systematically 
examined. Beginning with the head, the fingers should be 
passed gently over it in the search for wounds, depressions, 
or bruises. If the eyes are closed, the upper eyelid should 
be raised to permit of examination, and the open eye should 
be examined as to whether the pupils are dilated or con- 
tracted, of the same size or unequal, and whether the eyeball 
is sensitive to the touch. Passing down the neck in the 
same manner, the two sides of the body should be carefully 
compared and any variation noted ; the ribs and collar bones 
should be felt to see if they are sound. The breathing should 
be watched to see if it is easy or difficult, snoring or imper- 
ceptible, and the odor of the breath should be tested for 
indications of drugs or liquors taken. The arms and legs 
should then be looked over; the attitude, the increase or 
diminution of length of one as compared with the other, the 
possibility of bending at an abnormal point and crackling 
felt at the point, — all have their value and should be sought 
for. 

If a wound be discovered in some part covered by the 
clothing, it should be examined to see whether it needs treat- 
ment or not, and if dressings are demanded, the part should 
be uncovered to a sufficient extent to permit their ready appli- 
cation. The examination should be made with the greatest 
gentleness on account of the extreme sensitiveness of injured 



INDICATIONS OF DISEASES 1 23 

parts : and as little as possible of the person should be uncov- 
ered, for the natural tendency of an accident is to produce a 
greater or less amount of shock, which is manifested in a 
diminution of the heart's action with a cold feeling all over 
the body, often manifested by shaking chills and cold sweat. 
The chill, certainly, should not be increased by exposure of 
the body. The injured part should be exposed by ripping 
the nearest seam in the clothing and cutting the under- 
clothing under it, taking care to uncover no more of the part 
than is absolutely necessary for the dressings. 

When an injured person has been brought to his bed and 
has received proper attention, it will be desirable to remove 
his clothing. This should be done with the utmost gentle- 
ness, the sound side should be undressed first, and then the 
clothing removed from the injured side with as little disturb- 
ance as possible, assisting the process by ripping and cutting 
whenever the slightest difficulty appears. If it is necessary 
to replace the clothing upon an injured person, the injured 
side should be clothed first and then the sound side : but 
ordinarily no attempt should be made to put clothing on 
again — it is sufficient to lay it loosely about a patient. 

Indications of Diseases. — Certain conditions or appear- 
ances point toward the existence of certain affections : these 
are signs or symptoms. A flushed face is a symptom of 
fever, of apoplexy, of epilepsy, and of intoxication, while a 
pale face indicates poor circulation or faintness. The eyes 
afford important symptoms : if the pupils are enlarged and 
the patient unconscious, paralysis, apoplexy, or belladonna 
poisoning are indicated : if they are very much contracted, 
on the contrary, opium poisoning and congestion, and inflam- 
mation of the brain are indicated ; while if they are unequal. 
there is probably some brain trouble affecting but one side. 
Inability to move a limb or to feel sensations in a part indi- 
cate paralysis there : the same affection is indicated by a 
drawing of the face to one side and a dragging gait. 

Bleeding from the mouth or nose occurs in a large number 
of disorders and cannot be said to be in itself a distinctive 
symptom : but when frothy blood is coughed in considerable 



124 EMERGENCIES AND ACCIDENTS 

quantity from the mouth, bleeding from the lungs is to be 
suspected, and when the bleeding comes from the ears, nose, 
and mouth after a fall upon the head, fracture of the floor of 
the cranium has probably occurred. 

Fits, spasms, or convulsions also occur in a variety of 
affections and may be very violent in epilepsy, drunkenness, 
and in insanity, kidney troubles, and apoplexy ; comparatively 
slight causes, such as teething and even indigestion, will pro- 
duce them in children, and on the other hand they may indi- 
cate extensive brain disease. The drunken man staggers in 
his gait, but disease of the brain or spine may also cause 
irregularity in walking. 

A weak pulse is a sign of fainting, bleeding, shock, or 
collapse ; an irregular pulse indicates heart disease ; a slow 
pulse is a symptom of pressure on the brain and opium 
poisoning ; and a rapid pulse leads to a suspicion of fever, 
although it may be due to nervous excitement, or may be the 
normal condition of the patient. 

Difficult breathing may be due to a stoppage of the air 
passages, to broken ribs, to water in the chest, to disease of 
the heart or lungs, and to disease or injury of the breathing 
centre in the brain, or the nerves supplying the breathing 
apparatus. Snoring breathing, also called "stertorous," is a 
sign of pressure on the brain, as in apoplexy. Hiccup is 
a spasmodic breathing, and may be caused by indigestion, 
nervous trouble, and exhaustion. Coughing occurs in foreign 
body in the larynx, irritation in the windpipe or bronchial 
tubes, and in lung and heart disease. 

Dizziness may be due to digestive disorders, kidney troubles, 
and brain affections, while shivering chills, aside from cold- 
ness, may point to the beginning of fevers, or to weakness 
and danger in the course of an illness. 

It will be observed that it is rare that a single symptom 
points exclusively to a single disorder, and the physician 
relies upon a combination of signs for the identification. 
Typical cases of disease are rare, and two cases of the same 
affection may differ so greatly that the uneducated mind 
would never class them together. 



BRUISES 125 

Cases of feigning accidents or disease in order to profit by 
the sympathies of bystanders are not unknown. Indeed, men 
have been known to make an excellent living by simulating 
epileptic fits ; in cases of fits, then, where the fall is very 
gentle and always at a point where a generous contribution 
is to be expected, and where the convulsions are never directed 
toward a body, contact with which might hurt the subject, 
such cases should be looked upon with suspicion. All the 
symptoms are probably assumed and the froth at the mouth 
produced by a bit of soap. Blindness and deafness are fre- 
quently feigned, and it has been a common practice among 
mendicants to irritate ulcers and other sores in order to 
obtain an excuse for soliciting chanty. 



CHAPTER XVI 
BRUISES, BURNS, AND FREEZING 

Bruises. — Definition : Wounds under the skin. 

Causes: Blows, falls, squeezes, pinches. 

Symptoms : Pain, at first numb, later sharper. Swelling. 
Change of color : at first a purplish red, fading out to 
a greenish brown, and lastly to a dirty yellow. In 
severe cases the symptoms of shock are present. 

Treaf7nent : If it be slight, cold applications, in the form 
of wet cloths and sponges ; if more severe, cloths 
wrung out in hot water, and bran poultices ; laudanum 
directly to the part relieves pain. Very severe and 
extensive bruises may involve deep tissues to a great 
extent, and treatment appropriate to each case must be 
administered by a physician. Shock, however, should 
be treated with hot, dry fomentations pending his 
arrival. 

Bruises are technically known as contusions, and vulgarly as " black- 
and-blue spots," " black eyes," and by other names, varying according 
to the location. 



126 EMERGENCIES AND ACCIDENTS 

The discoloration is caused by blood issuing usually from capillary 
blood-vessels, broken under the skin by the violence which has torn 
the surrounding tissues to a greater or less extent. Where the tissues 
under the skin are loose and spongy, a considerable amount of dis- 
coloration may occur. This is seen in the "black eye," where the 
amount of blood issuing into the tissues may be quite considerable. 
The discoloration does not appear at once, since it takes some little 
time for the blood to spread into the tissues sufficiently to be seen 
under the skin, but it is usually apparent in from a few minutes to sev- 
eral hours. However, if the parts especially bruised lie very deep, as 
when a bone is broken, it may take several days for the color to reach 
the skin. The blood soon begins to decompose to a suitable condition 
for absorption, and as the color fades out it is carried off and discharged 
from the system. The time required for the return to the normal color 
occupies a period varying — according to the extent of the injury — from 
a few days to several weeks, and even longer, in very severe cases. 

While it would seem that without a break in the skin, an injury could 
not be very severe, as a matter of fact, the greatest amount of damage 
may be accomplished. The entire substance of a limb may be crushed 
to a pulp ; large veins and arteries may be torn ; the liver, kidneys, or 
spleen may be broken, and the stomach or bowels may be bursted, 
while the brain is peculiarly subject to such injuries, — without any ex- 
ternal wound. In these severe cases the symptoms are correspondingly 
accentuated. Where the chest or abdomen has been bruised, injury to 
their contents is shown by spitting or vomiting blood, or passing it from 
the bladder or bowels. This is usually accompanied by great pros- 
tration, with feeble pulse, cold, clammy skin, anxious expression, and 
bewildered mind. The most important point of treatment in this case 
is to counteract the tendency to weakness by the application of warmth, 
inside and out. Hot, dry fomentations, consisting of bottles of hot 
water, hot flatirons, hot stove-lids — in fact, anything hot that can be 
obtained quickly, taking care to cover it, so as not to burn the patient's 
skin — should be applied at once. Hot drinks should be given him, 
coffee preferably, but in default of that any similar material. On 
account of their effect upon bleeding, alcoholic drinks should not be 
given. And, above all, a surgeon should be distantly summoned / 

Where the accident affects larger vessels than the capillaries, the 
amount of blood lost into the tissues may be very large, and form a 
hematoma or " blood-tumor," and these require the care of a physician. 
#an artery is torn, the swelling forms very rapidly, and beats with the 
heart like the pulse of an artery. 

In large bruises the parts may be so injured as to make it necessary 
to remove the bruised limb ; and even in comparatively slight bruises 
the blood may break down into an abscess which has to be opened to 
let the matter out. Paralysis of a limb, necrosis or death of a part, and 
long-continued tenderness may result from an extensive bruise. 



BURNS 127 

The treatment looks toward three points: (1) to stop the issue of 
blood; (2) to hasten the removal of blood already in the tissues; and 
(3) to diminish any resulting inflammation. 

The first indication is fulfilled by the application of cold water or 
chopped ice to the bruise. 

Both the first and second are fulfilled by stimulating washes ; a 
mixture of three drachms of table salt and one drachm of muriate of 
ammonia in six ounces of baywater is perhaps the best of these ; dilute 
alcohol and a mixture of dilute alcohol and water are also excellent 
applications for this purpose. 

The second indication is also well fulfilled by kneading or rubbing 
the bruise with oil or a simple liniment, and by pressing a compress 
firmly upon it. The application of a mass of raw lean beef, so popular 
in the treatment of " black eyes/' also belongs to this class. 

The third indication is fulfilled by the cooling applications already 
mentioned. If an abscess should form, it should be treated by a 
surgeon. 

Pain may be treated, in addition to the applications detailed, by the 
administration of anodynes, locally and internally, and always under 
the direction of a medical man. 

Burns. — Definition : Injuries due to the action of too great 
heat on a part. 

Causes : Contact with fire, very hot bodies or chemicals. 

Varieties : Burns are divided into three classes, accord- 
ing to the degree of severity of the injury: (1) Mere 
painful redness. (2) The formation of blisters. 
(3) Charring. 

They are also classified, in accordance with the mate- 
rial inflicting the injury, into (a) burns, produced by 
contact with fire, hot solids, or chemicals, and (b) scalds, 
caused by hot liquids. 

Symptoms : Pain. Simple reddening of the skin in the 
first class, redness with the formation of blisters in the 
second class, and actual destruction of the skin and 
more or less of the underlying tissues in the third. 
In burns of the first two degrees, the skin only is 
involved, while in charring there is no limit. In severe 
burns there is apt to be a great amount of prostration 
with the symptoms which together form shock, de- 
scribed in the chapter on Fainting. 



128 EMERGENCIES AND ACCIDENTS 

Treatment : Remove the clothing by cutting it away 
with a knife or scissors ; if it sticks, do not pull it off, 
simply cut around it and flood it with oil. 

Let the water out of blisters by pricking them with 
a new and absolutely clean needle or pin, and gently 
pressing them, taking great care not to break them 
and expose the tender surface underneath. 

Promptly exclude the air by : — 

a. In case of a slight burn of the first degree, and 
in particular of a scald, applying a compress wet with 
water in which is dissolved as much baking-soda as 
the water will take up. 

b. In any case, applying any clean oil such as salad 
oil, olive oil, sweet oil, fresh lard, unsalted butter, 
vaseline, cosmoline, petrolatum. The white of an egg 
is even better than these, and all of them are improved 
by being carbolized by the addition of fifteen grains of 
carbolic acid to the ounce. 

c. Better, however, by applying " carron oil," a mix- 
ture of equal parts of linseed oil and lime water. 

d. In the absence of oils, by dusting flour or whiting 
over the burn. If nothing else can be gotten, moist 
earth, preferably clay, makes a useful application. 

Cover the part with cotton or the nearest available 
substitute for it. 

Burns caused by acids, such as oil of vitriol or sul- 
phuric acid, carbolic acid, and the like, should first be 
thoroughly drenched with water and then washed with 
a solution of washing or baking soda and water ; then 
treated like an ordinary burn. 

Burns caused by alkalies, such as caustic potash, 
caustic soda, strong ammonia, and the like, should first 
be thoroughly drenched with water and then washed 
with vinegar or some other dilute acid; then treated 
like an ordinary burn. 

Treat shock by hot, dry fomentations and warm 
drinks as prescribed in the chapter on Fainting. 

In severe cases send for a physician. 



BURNS 129 

Burns are by surgeons divided into six classes instead of three, as 
follows: (1) Simple redness of the skin. (2) Redness, with slight 
blistering, which leaves no mark after recovery except, perhaps, a slight 
stain. In these two classes the burn does not go below the epidermis 
or scarf skin. (3) Partial destruction of the true skin also, which leaves 
a scar, but no deformity. (4) Entire destruction of both scarf skin and 
true skin, which invariably leaves a scar, and always produces deformity, 
sometimes frightful in extent. (5) Destruction of muscles and other 
soft parts, followed by great deformity and possible loss of limb, if 
recovery takes place. (6) Charring of the entire thickness of a limb, 
which always imposes loss of the limb if the patient survives. 

Burns are more frequently the result of carelessness than not. But 
they cannot always be avoided, as in accidents of various kinds, such as 
explosions of gas and gunpowder, explosions of lamps, falls upon stoves 
or into fireplaces, burning clothes, and the like. Scalds are caused by 
contact with steam, hot water, and other fluids. 

The pain attending a burn is very intense, and the removal of cloth- 
ing by cutting, instead of pulling it off in the usual way, is designed to 
avoid increasing it as well as to avoid tearing of the blistered skin and 
exposing the exquisitely tender surface below. 

The chief indication in severe burns is to cover them as quickly as 
possible with something that will exclude the air. The application 
should be ready to apply the moment the clothing is removed. A very 
brief delay is likely to be fatal to the patient, from exposure of the 
burned surface to the air, especially in case of the chest and abdomen. 
For this reason it is well, where a burn is extensive, to expose and dress 
but a small portion of the burn at a time. 

Baking-soda water — the bicarbonate, not washing soda or baking 
powder — and the oils are best applied by dipping into them, and the 
ointments like vaseline, by spreading them thickly upon, cloths, which 
are then immediately laid upon the burned or scalded surface. Both 
baking soda and carbolic acid have a soothing effect upon the pain. 
It is well to complete the dressing of a burn by covering the cloths with 
layers of cotton batting, cotton wadding, flannel, oakum, and other simi- 
lar materials which should be bound lightly upon the part. 

The inside of the mouth and throat may be scalded by drinking hot 
fluids or swallowing chemicals. In addition to the dangers attendant 
upon burns in other parts of the body, choking and smothering from 
swelling in the throat is to be feared in this case. Cloths cannot be 
applied here, and the oil or the white of an egg must be applied by 
drinking them. If the injury is due to chemicals, the mouth and throat 
should be rinsed by the proper antidote — vinegar or exceedingly dilute 
acid in case of caustic soda, potash, ammonia, or lye, and a solution of 
baking soda or washing: soda in case of an acid. 

It does no good to hold a burn to the heat, and the exposure may 




I30 EMERGENCIES AND ACCIDENTS 

often cause great injury to the system. Warm moist cloths are, how- 
ever, very grateful in slight burns. 

Where charring has occurred, more or less of the tissues have been 

killed, and the dead or " necrosed " portions will be cast off with the 

formation of matter. In these cases, the physician will take great care 

to use antiseptics to prevent infection of the wounds by micro-organisms. 

The process of casting off the dead matter 

may be hastened by the use of poultices, 

which must be antiseptic. 

Where the entire skin has been involved 
in a burn, the healing will form a trouble- 
some scar which will ultimately contract 
and produce a deformity varying in degree 
Pig. 94. — Deformity of the according to the extent of the burn. The 
hand, due to a contract- accompanying illustration shows a deformity 
ing scar after a burn. of the hand due to a contracting scar after 

a burn. It is one of the milder cases; the 
deformities are often frightful in the extreme. To avoid this as much 
as possible, the parts should be placed in a natural position while heal- 
ing and kept so. 

Sunburn is caused by exposure to the rays of the sun, and is a burn 
of the first degree — simple redness of the skin ; mustard causes a simi- 
lar condition. The application of baking-soda water and of oils, un- 
salted lard and butter, white of egg and vaseline — plain, but preferably 
carbolized — is indicated here as in other burns of the same class. 

Sunstroke and heatstroke, although they are accidents due to the action 
of heat, are considered to be best treated in the chapter on Fainting. 

Burning Clothing, particularly that of females, has been 
the unnecessary cause of many horrible deaths, either from 
ignorance of the proper means of extinguishing the flames, 
or from lack of presence of mind to apply them. A person 
whose clothing is blazing should (1) immediately be made 
to lie down — be thrown down, if necessary. The tendency 
of flames is upward, and when the patient is lying down, they 
not only have less to feed upon, but the danger of their 
reaching the face, with the possibility of choking and of ulti- 
mate deformity, is greatly diminished. (2) The person 
should then quickly be wrapped up in a coat, shawl, rug, 
blanket or any similar article, preferably woollen, and never 
cotton, and the fire completely smothered by pressing and 
patting upon the burning points from the outside of the 
envelope. 



FREEZING 131 

The flames having been controlled in this way, when the 
wrap is removed, great care should be taken to have the 
slightest sign of a blaze immediately and completely stifled. 
This is best done by pinching it. but water may be used. 
Any burns and any prostration or shock should be treated in 
the manner prescribed for them. 

It is always dangerous for a woman to attempt to smother the burn- 
ing clothing of another, on account of the danger to her own clothing. 
If she attempts it, she should always carefully hold between them the 
rug in which she is about to wrap the sufferer. 

Freezing. — Definition : An injury due to the action of too 
great cold on a part. 

Causes : Exposure to excessive cold. 

Varieties : (1) The frost bite, where portions only of the 
system have been affected. (2) General freezing, 
where the entire system is affected. 

Symptoms : (1) Of the frost bite: Affecting projecting 
points on the person, such as the ears, nose, lingers, 
and feet, the affected part first tingles with pain and is 
red, and then blue or purple in color ; as the freezing 
goes on. the part becomes white and free from pain. 

(2) Of general freezing : The entire person, under 
exposure to severe cold, becomes chilled, stiffened, and 
pale ; the mind becomes sluggish and drowsy ; the 
extremities are benumbed and shrunken ; unconscious- 
ness supervenes, and unless proper restorative means 
are applied, death ensues without awakening. 

Treatment : (1) Of frost bite: Too rapid warming is apt 
to cause mortification, hence the frozen part should be 
restored by rubbing with snow or with cold water 
until the white color is replaced by the natural hue 
and an aching pain is felt in the part — then treat like 
a burn. 

(2) Of general freezing: In a dry, cool room which 
can be gradually heated, but not near a fire, the clothing 
should be removed and the body rubbed briskly and 
carefullv, at first with snow or cold cloths, and then 



132 EMERGENCIES AND ACCIDENTS 

with dry flannel ; as soon as the ability to swallow is 
restored, stimulants and hot drinks should be given ; 
upon restoration the patient should be snugly wrapped 
in warm clothing and put to bed ; individual frost bites 
being treated as above. 

Under ordinary circumstances, an hour's exposure to intense cold 
may determine a fatal result. This outcome, however, maybe modified 
by circumstances : a covering of snow retains the heat of the body to 
such an extent as to considerably delay death ; well authenticated cases 
are on record in which persons, buried even for days in the snow, have 
nevertheless survived and ultimately recovered with little permanent 
damage. 

In a still day a very low temperature can be endured with compara- 
tive comfort, while a wind will make a much warmer day productive of 
great suffering. The rapid movement of the surrounding air carries 
away from the surface of the body the warmth which remains undis- 
turbed on a quiet day. 

When a part is frozen, it becomes bloodless, as is shown by the white 
color, and the object of treatment is to bring the blood back into the 
emptied tissues. There is danger, however, if the return of the circula- 
tion be produced too rapidly, that the resulting excess of blood in the 
part will produce mortification and decay, — gangrene and sloughing, — 
and for this reason, cold applications are combined with the rubbing, 
by which the circulation is restored. 

The effect of cold is very similar to that of heat, and frost bites are 
much like burns, so much, indeed, that the after-treatment is the same. 
Like heat, cold produces blisters, which are treated by careful pricking 
with a new and absolutely clean needle or pin, pressing the fluid out, 
and dressing the frozen surface with oils or ointments. 

Like charred burns, the dead matter resulting from the mortification 
of a frozen part should be treated antiseptically, and the process of 
throwing it off hastened by an antiseptic poultice. 

Chilblains are the result of too rapid warming of cold feet. The 
blood having been to a considerable extent crowded out of the feet by 
the cold, when they are rapidly warmed, it finds its way back in so large 
a quantity that it cannot all be disposed of, and the excess can be seen 
collected in small patches, scattered over the sole of the foot — the chil- 
blains. This form of congestion sometimes becomes chronic in persons 
of poor circulation. An individual subject to chilblains should never 
come in out of the cold and toast his feet at a warm fire. He should 
warm them by stamping or briskly rubbing them, and by warming 
other parts of the body. Astringent applications to his feet, such as 
alcohol or alum water, will usually control them when they have been 
developed. 



WOUNDS 133 

CHAPTER XVII 

WOUNDS 

Wounds. — Definition: Injuries, in which an opening is 
made through the skin and more or less of the parts 
underneath. 

Varieties : (1) Cut or incised wounds ; (2) Torn or lac- 
erated wounds ; (3) Bruised or contused wounds ; (4) 
Pierced or punctured wounds, including gunshot 
wounds ; (5) Poisoned wounds. 

Causes .\(i) Of cut wounds, blows with sharp-edged in- 
struments, such as knives, razors, and swords ; (2) Of 
torn wounds, blows with blunt instruments, such as 
clubs or stones ; irregular* bodies, like fragments of 
shell and forcible tearing of a part from the body ; 
(3) Of bruised w< ounds, blows with blunt instruments — 
torn wounds are usually bruised also ; (4) Of pierced 
wounds, thrusts with narrow, sharp-pointed instru- 
ments, such as bayonets, arrows, and daggers — a gun 
or pistol shot also produces a punctured wound ; (5) 
Of poisoned wounds, usually bites of venomous reptiles 
or insects. 

Symptoms : Pain at the point of injury. An opening 
through the skin. Bleeding, varying in amount ac- 
cording to the injury. Where bones are broken, the 
signs of that injury. 

Treatment : 1 . If the wound be a large or disabling one, 
lay the patient in as comfortable a position as possible. 

2. Stop the bleeding as far as practicable by the 
employment of the means described in the chapter on 
Bleeding, taking care not to destroy the clot, if one 
has formed. 

3. Cleanse the wound from bits of glass, stone, 
splinters of wood, dirt, or any other matters of the 
kind, by washing with absolutely clean water, rendered 



134 EMERGENCIES AND ACCIDENTS 

antiseptic if possible by a tablespoonful of common 
salt to the pint, or vinegar in the proportion of one 
fourth ; or. better, carbolic acid or corrosive sublimate 
solutions, prepared as directed in the chapter on Germs. 
If clean water cannot be obtained, do not wash the 
wound ; simply pick out the larger particles. 

4. Place the edges of the wound as nearly as possi- 
ble in their natural position. 

5. Set any broken bones by the methods related in 
the chapter on Broken Bones. 

6. Use a first-dressing packet in accordance with 
directions, if available ; if not, apply compresses, pre- 
pared according to the methods detailed in the chapter 
on dressings, wetting them with the same antiseptic 
solution used for cleansing. Bandage this dressing 
neatly in place. 

7. Apply splints, if necessary, not binding them di- 
rectly upon the wound. 

8. Apply a triangular bandage over the wound now 
dressed, and if it affect an upper extremity, support it 
in a suitable sling, as detailed in the chapter on Band- 
aging, and keep it quiet. 

9. Treat shock by hot drinks, and hot, dry fomen- 
tations, as directed in the chapter on Fainting. 

Through the appreciation of the germ theory, both the treatment of 
wounds and its results have, within a few years, undergone striking 
changes. The recognition of the fact that bad results and slow healing 
of wounds are due to the presence of poisons, developed by noxious 
germs, which have found their way into wounded tissues, has led to the 
observance, by surgeons, of the strictest precautions to prevent the 
entrance of germs, and to destroy or paralyze them if they should gain 
access to them. And by doing this, the surgeon of the present day is 
able to perform operations that would in former times have been con- 
sidered as actual murder. With improved means of proceeding, hardly 
any part of the body is sacred from the surgeon's knife. We saw open- 
ings into the skull, and operate upon the brain; we open the belly and 
cut out kidneys, spleens, and parts of the stomach and bowels, the liver 
and pancreas, the bladder, and whatever other organs are contained in 
the abdomen ; we open up joints and nail bones together, or cut out 
pieces of them ; we cut off bits of the lungs, and even the heart itself is 



WOUNDS 135 

likely to become subject to operation at no distant day, for it has already 
been pierced, and had blood pumped out of its cavity. 

Several circumstances modify the danger of a wound, such as its 
depth, its extent, and its location. The character of the deeper parts 
affected also has a powerful influence upon the result : wounds of the 
blood-vessels are likely to result fatally, unless the bleeding is checked; 
wounds of the brain, lungs, and intestines are likely to be followed by 
death, unless treated with the utmost skill and care ; heart wounds rarely 
fail to be mortal, while those affecting the tones and joints are liable 
to complications which may induce death. 

The kind of wound inflicted also affects the result. Punctured 
wounds, such as stabs and shot-wounds, are the most dangerous in 
proportion to the amount of external injury inflicted, both because they 
may penetrate deep enough to sever a blood-vessel or injure other vital 
organs, and because foreign bodies, such as bits of clothing and splinters 
of bone, may have been carried into the wound in addition to the bullet, 
which is generally harmless to the surrounding tissues. 

In a chapter devoted to the subject, methods of checking bleeding 
will be discussed in detail. It will be seen that bright red blood spout- 
ing in a jet from a wound indicates that an artery has been opened, and 
that such bleeding may be stopped by pressure upon a limb above the 
wound, or by thrusting a finger or thumb into the wound itself and 
holding it there until other means of arresting bleeding have been 
applied. If the bleeding consist of dark, blackish red blood pouring 
steadily from the wound, it will have originated in an injured vein, and 
this should be treated by pressing a thumb or finger into the wound 
until other more serviceable means of treatment can be applied. In 
either one of these cases a surgeon should be summoned immediately, 
especially if the amount of bleeding be great, and, meanwhile, no 
other dressings can well be applied except where bleeding has been 
checked by pressure above the wound, or by a plug in it : in this case 
a wet compress may be laid upon the wound pending the arrival of a 
surgeon. The wound, however, should still be watched with increas- 
ing vigilance, so that any recurrence of bleeding may be observed at 
once. 

Slight bleeding, especially that from the capillaries, may be readily 
controlled by the application of a little hot or cold water, and by the 
pressure of dressings which may be "applied at once. 

Cleanliness is of Vital Impo?'tance to Wounds. All foreign matters 
should be removed. Dirt, bits of glass, gravel, or cloth, splinters of 
wood, fishhooks, pins or thorns, should be picked out and the wound 
washed with clean, or, preferably, clean water with germicides — corro- 
sive sublimate, carbolic acid, salt, sugar, vinegar, etc. — in solution. 
Micro-organisms contained in water are killed by boiling, and fresh- 
boiled water may always be used with advantage where antiseptic solu- 



136 



EMERGENCIES AND ACCIDENTS 



m0* 



Fig. 95. - 



tions cannot be obtained. In washing wounds, use absolutely clean 
materials, sponges, or masses of absorbent cotton or gauze if available, 
and failing these, use clean handkerchiefs or other linen, or paper. 
Do not use materials torn from the clothing of the patient or by- 
standers. 

The wound should not be mopped with the sponge, and except in 
assisting in the removal of something especially difficult to extract, 
should not be allowed to be touched by it. The sponge should be 

dipped into the water 
and then held in the 
closed hand a few 
inches above the 
wound, with one cor- 
ner protruding, and 
gently squeezed so as 
to cause a single stream 
to trickle gently down 
upon the injured sur- 
face. The force of the 
flow of the fluid used 
for washing should be 
varied according to the 
difficulty of washing 
away the dirt ; the size 
of the stream can be increased by squeezing the sponge harder, and its 
force by holding it at a greater distance from the wound. 

Unclean water should never be used — a wound had better be left 
dry. Stagnant water is particularly liable to be full of vegetable and 
animal microscopic life. 

Any hair in the vicinity of a wound should, if possible, be carefully 
clipped short, and preferably shaven, to obviate any irritant action by 
its contact with the wound. 

Having cleansed the wound, the injured parts should be carefully 
drawn as nearly as possible into their original position. This is of 
importance in diminishing the size of the scar. In a simple cut, if the 
edges are promptly drawn closely together, healing will occur without 
leaving any scar. The rapidity and completeness of the healing in such 
cases is often astonishing. Where a greater or less part of a finger or 
toe has been cut off with a sharp instrument like a knife or an axe, it 
has often been made to unite to the stump by binding it closely to the 
point whence it has been removed. In these cases, the amputated 
finger or toe has often readily grown again to its old place. A finger 
or toe, then, which has been cut off should be immediately fitted into its 
place and neatly bound there in order to give it a chance to grow to the 
body again. 



■ How to squeeze a sponge in washing a 
wound. 



CLOSING WOUNDS 



137 



The preferable method of retaining the edges of wounds together 
is by means of stitches of antiseptic materials ; the surgeon uses silk, 
catgut, silkworm gut, and a number of similar materials. Horse hair 
properly treated may be used with advantage. Stitching, however, 
should not be attempted except by a medical man, or one who has had 
practical experience in the manoeuvre under the eye of a surgeon. 
Stitching a wound leaves a much smaller scar than any other means of 
closing, and where a surgeon can be obtained, a wound should always 
be so treated. 

Sticking-plaster will retain the edges of a 
wound together superficially, but it is impossi- 
ble to keep an injury clean with plaster sticking 
to it, and where practicable to avoid it, the 
plaster should not be used. If, however, one 
is driven by necessity to use it, the wound 
should never be entirely covered by the plaster, 

since it would then confine any matter which might be secreted. The 
edges of the wound should be drawn closely together and held in place 
by narrow strips of plaster, leaving intervals between them for the escape 
of secretions and the contact of dressings. Where there is a marked 
tendency for the edges to gape, a larger sticking surface may be obtained 
by making the plaster a little larger at either end. 

However, where adhesive plaster spread on muslin, such as surgeons 
use, is available, all contact of the plaster with the wound may be avoided 
by taking two strips of plaster one or two inches wide and a trifle longer 
than the wound. Lay these on either side of the wound with their inner 



Fig. 96. — Mode of cutting 
strips of plaster to afford 
a larger sticking surface. 




Fig. 97. — Wound closed by sticking plaster and laced threads. 



edges a half an inch from it on either side, parallel to it and leaving 
about a quarter of an inch of the upper margin loose and having the 
remainder tightly stuck. Then with a needle and thread, preferably 
silk, draw the edges of the wound together by lacing the free edges of 
the plaster as shown in Fig. 97, fastening the thread at either end with 




I38 EMERGENCIES AND ACCIDENTS 

knots and pressing the plaster firmly down as soon as the thread has 
been drawn tight. 

Any hair should be cut, by shaving, if possible, from localities where 
the plaster is to be applied. If the hair is left in place, the removal 
of the plaster sticking to it will be painful. Strips of sticking-plaster 
should not be drawn completely about a limb, on account of the 
danger of interference with the circula- 
tion of the blood in the extremity. In 
removing strips of plaster from a wound 
where it has been applied, the two ends 
should each be raised as in Fig. 98, and 
that part lying over the wound removed 
last. 

Where stitching and closure with stick- 
ing-plaster are both impracticable, the 
Fig. 98. — Mode of removal of parts should be drawn together as well 
sticking-plaster strips. as possible, and a compress applied and 

bandaged in place. 
In dressing a wound, two objects are to be considered : (1) to retain 
the parts in a position suitable for healing, and (2) to prevent future 
dangerous complications. To fulfil the first, we apply stitches, adhesive 
plaster, compresses, splints, and bandages. The fulfilment of the 
second demands care against (a) catching cold, (6) getting into painful 
positions, or being jarred, and (c) the access of micro-organisms. 

The parts having been cleansed and brought into proper position, 
the application of a compress is the next procedure in order. In the 
chapter on Dressings and Applications, the method of preparing com- 
presses has been fully described. After a pad of antiseptic gauze, cloth, 
lint, oakum, cotton, paper, or other proper substance has been duly 
prepared, soaked with clean water, preferably boiled, or an antiseptic 
solution, it is gently placed upon the wound and made to lie closely 
upon it. As has already been noted, where absolutely clean water or 
antiseptic solutions cannot be obtained the dressings may be applied 
dry. 

The compress is then bound securely in place by a triangular band- 
age, a folded handkerchief, or possibly a roller bandage, and the part 
placed in a comfortable attitude. The bandages may be left in place 
until the wound heals, or until the production of matter of a disagreeable 
odor shows that the dressings need renewing. 

The injured part should lastly be placed in such a position as to give 
the patient the least discomfort, whether he remains on the spot or is 
carried away. If the head be so injured that the patient is unable to 
hold it up, he should be laid down with the head resting upon a pillow, 
extemporized, if necessary, from folded clothing, hay, straw, grass, or 
any other material which would answer the purpose, taking care that 



TORN AND PIERCED WOUNDS 1 39 

the injury be kept from contact with the surrounding articles which 
might prove painful. If the arm be injured, it should be supported in 
a sling if the patient is able to walk ; or supported in a comfortable 
attitude either across the body or by his side, if it be necessary to carry 
him. If a lower limb be affected, it may be supported by pillows, 
extemporized if necessary, in such a position as may be comfortable, 
while at the same time not tending to disturb the parts. If the chest be 
injured, the head and shoulders should be raised by pillows until the 
patient is able to breathe comfortably, the body being turned slightly 
to the injured side. If the belly be wounded, the patient should be 
made to lie down with his knees well drawn up and turned upon the 
injured side, or upon the back if the wound is in front. 

Tom or lacerated wounds are almost always bruised as well, but are 
characterized by ragged edges. They may be caused by stones or 
bricks, clubs or broken glass, machinery, and many other agents. They 
may be dangerous in the extreme, especially in connection with accidents 
due to the railway, or machinery. An entire limb may be torn away, or 
it may be so crushed as to require to be amputated. In these accidents 
it often happens that the blood-vessels are so twisted as to close them, 
and render the bleeding comparatively trifling. Such injuries are to be 
treated temporarily like ordinary wounds — foreign matters are to be 
removed, the parts cleansed and covered with suitably prepared com- 
presses, bandaged, and placed in as comfortable a position as possible. 
The pain in extensive injuries of this kind is often not very great, but 
the depression or shock is likely to be extreme ; it should be treated 
with hot, dry fomentations, hot drinks, and the like, as detailed in the 
chapter on Fainting. Where the head, chest, or belly has been crushed, 
the accident is almost always immediately fatal ; but in other localities, 
recovery occasionally occurs in apparently desperate cases. Small 
wounds of the head and face, because of the abundant blood supply, 
usually unite promptly, and with but a trifling scar, if the parts are 
neatly drawn together. Torn wounds generally, however, heal slowly, 
and by granulation, producing a greater or less amount of offensive 
matter, requiring frequent renewals of the dressings. 

Pierced or punctured wounds are caused in war, by bayonets, swords, 
arrows, daggers, and similar implements; and in peace, by needles, 
thorns, splinters, fish-hooks, bits of glass, and other articles of like 
character. The immediate treatment of pierced wounds in general, 
after the piercing body has been removed, consists simply in the appli- 
cation of suitable wet compresses. If the wound be large, the injury of 
important organs of bleeding may modify the treatment. Upon re- 
moving a needle, examine it, to see if any of it has been broken off in 
the flesh. If any portion has been left behind, or if the whole needle 
has been pushed in, do not try to remove it, but keep the part absolutely 
still, and summon a surgeon. Any movement of the part will cause 



140 



EMERGENCIES AND ACCIDENTS 



muscular contractions, which may so move the needle in the flesh that 
it cannot be found when the surgeon comes to look for it. Thorns 
should be pulled out, and, if poisonous, the wound should be treated 
like a poisoned wound. 

Splinters should be pulled out by slipping the point of a pen-knife 
under the protruding end of the splinter, catching it against the blade 
with the thumb nail, and drawing it out. If the end does not protrude, 
the scarf skin over it can be pricked away with the point of the knife, 




Fig. 99. — How to pull out a splinter. 



until the end of the splinter is uncovered, when it can be removed 
as before. If a splinter be located under a nail, and the end be 
broken off so that it cannot be reached, the nail over the splinter 
should be scraped thin to the tip on the outside; a little tongue can 
then be gently cut out over the end of the splinter, which may then 
be raised on the point of the knife, and drawn out as in other parts. 
When the splinter cannot all be removed in this way, the cutting away 
of the nail will make it easier for the remainder to work its way to 
the surface after the formation of matter. A splinter in the eye may 
be drawn out, as in other parts, if it can be reached. If it cannot 
be reached, the eye should be covered with a cold, wet compress, 
and so kept until the arrival of a medical man. On no account 
should a non-medical person attempt to interfere with splinters buried 
in the eye. 

In the case of needles or large splinters, where a portion may possibly 
remain in the flesh, the part which has been pulled out should be kept 
to show to the medical adviser when he shall have arrived, in order to 
assist him to determine the character of the portion left behind. 



PENETRATING WOUNDS I4I 

Fish-hooks and arrows in the tissues demand much the same treat- 
ment, the difficulty in removing both being due to the barbed point. 
As fish-hooks never penetrate deeply, they can readily be pushed through 
the tissues — they should never be drawn back unless the barbed point 
has been cut off. The best method of treating fish-hooks in the flesh is 
to draw them through : this procedure is assisted by cutting off the loop 
by which they are connected to the lines. So with arrows — where the 
tip lies near the surface, and important organs are not in the way, — 
they may be pushed through. Where this is impossible, a string should 
be firmly tied about the shaft, so that it cannot slip, within a half an inch 
of the wound, and the shaft should then be cut off a half an inch above 
that point. The wound should then be treated with antiseptic com- 
presses, until a surgeon can remove the arrow. The string will prevent 
the arrow's being lost, should an accidental movement push it into the 
tissues. 

Gunshot wounds, including pistol-shot wounds, are pierced and often 
torn wounds. Xike other wounds, they should be treated by checking 
bleeding, removing superficial dirt, applying antiseptic compresses, and, 
lastly, splints to prevent unnecessary movements. Often the bleeding 
from these wounds is very slight, and is checked by the simple pressure 
of the dressings. There is apt to be much depression and other symp- 
toms of shock, which should be treated by hot drinks, and hot dry 
fomentations, as directed in the chapter on Fainting. The bullet is apt 
to be the source of much anxiety to the uninitiated. Ordinarily, there 
is no danger whatever in the presence of a bullet in the tissues. It is 
the wound made by the bullet that bothers us. There are thousands of 
men walking about the country to-day with bullets in their bodies, which 
are not of the least trouble to them. A shot wound, then, should be 
treated like an ordinary wound, and without regard to the presence of 
the bullet. 

Wounds of the chest may penetrate into its cavity or not. If they do 
not, their treatment is the same as that of simple wounds in other parts. 
If they do penetrate, they are liable to involve the organs contained 
within it. If the heart is wounded, death usually quickly follows; 
although that this is not always so is shown by a considerable num- 
ber of cases recorded in surgical literature. If the lung be wounded, 
difficulty of breathing, coughing, and spitting of blood will occur, and 
the lung may protrude through the wound. Such an injury should be 
treated by making the patient lie down upon the wounded side, so as 
to let the blood drain to that side, and keep absolutely quiet : an attempt 
should be made to check excessive bleeding, and the wound should be 
dressed with a compress, and the entire chest closely surrounded with 
bandages. Penetrating wounds, in rare instances, do not involve the 
organs in the chest. 

Hounds of the abdomen, like those of the chest, may penetrate into 



EMERGENCIES AND ACCIDENTS 




Fig. 100. — Relations of the organs of 'he chest 
and abdomen to the clothing. 



the cavity or not. If they do 
not, their treatment is the same 
as that of simple wounds in 
other parts. If they do pene- 
trate, they may involve the 
organs of the belly or not. 
The bowels or other parts may 
protrude from the wounds, and 
may or may not be injured. 
If the bowels or other parts 
protrude, they should be care- 
fully examined, — the hands 
having previously been washed 
either with an antiseptic solu- 
tion or with clean water, — and 
if they are uninjured, gently 
pushed back into the belly. 
If they have been injured, they 
should not be returned, but 
should be covered with wet 
fomentations as hot as can be 
comfortably endured with the 
hand. These in turn should 
be thoroughly covered to pre- 
vent cooling. And a surgeon 
should have been summoned. 

All wounds of the body are 
likely to produce great shock, 
and every effort should be 
made to sustain the victim by 
hot drinks and other treatment 
appropriate to this condition. 

Penetrating wounds affect 
different organs according to 
their location. In Fig. ioo an 
effort has been made to show 
the relations of these organs 
to the uniform of the soldier, 
and from it a similar notion 
of the relations of the clothing 
of others may be derived. 

In the chapter on Bones, 
the method of identifying the 
different vertebrae of the spine 
has been related. The verte- 



DANGERS OF WOUNDS 



143 



brae bear constant relations to the organs of the chest and belly, and 
by an examination of them an idea of the parts probably injured in a 
wound of the body may be obtained. It is easy to discover the spinal 
processes of the vertebrae by briskly rubbing the hand up and down 
along the back of the spine, when each one will be marked by a red 
spot. The following table, from Holden's Landmarks, indicates the 
relations : — 



Cervical J 5th. 

Vertebrae. / 7th. 

f 3d- 



4 th. 



Dorsal 
Vertebrae. 



Beginning of the oesophagus or " gullet." 
Upper extremity of the lungs. 

(a) Apex of the arch of the aorta, the great funda- 
mental blood-vessel of the body, (b) Division of 
the trachea or " windpipe " into two primary bron- 
chial tubes. 

(a) Upper margin of the heart, (b) The begin- 
ning of the arch of the aorta on the right side, and 
(c) its end on the left side. 
Apex or lowest point of the heart on the left. 
(a) Passage of the oesophagus or " gullet," through 
the diaphragm or " midriff" into the abdomen or 
" beilv." (b) Upper edge of the spleen on the 
left. 

(a) Lower edges of lungs. (b) Upper orifice of 
stomach on the left. 
Lower edge of spleen on the left. 
(a) Lowest part of the cavity of the chest (b) Pas- 
sage of the aorta through the diaphragm. 
(a) Arteries of the kidneys, and (b) the centres of 
the kidneys themselves on both sides. 
(a) End of spinal cord, (b) Pancreas or " belly 
sweetbread." 
Umbilicus or "navel." 

(a) Division of the aorta, (b) Highest part of the 
hip bones on both sides. 

The dangers of wounds, when not properly treated, are many. Blood 
poisoning, gangrene, or death of a part, excessive production of matter, 
together with great depression due to it, long-continued inflammation, 
and high fever are liable to follow any wound, and are due to the fact that 
micro-organisms have gained access to the wound. Even the smallest 
wounds may be productive of the most unfortunate consequences, when 
neglected. Small scratches and pricks, when not properly cared for, may 
result in inflammations a d formations of gatherings or abscesses, which 
may disable a person for a considerable time, or cause loss of a limb, or 
even of life itself. This fact still further emphasizes the necessity for the 
utmost care in removing all impurities from a wound at once by washing 



Lumbar 
Vertebrae. 



8th. 
\ 9th. 



10th, 

nth, 
12th, 

1st. 

2d. 

3d. 

4 th. 



144 EMERGENCIES AND ACCIDENTS 

with clean water at least, and covering the wound with a bandage of 
some kind to protect it from contact with possibly injurious matter. 

The process of healing of wounds varies according to the nature of 
the injury and the character of the treatment. The processes may be 
grouped into two general classes, (i) Primary union or " first intention," 
and (2) Secondary union or " second intention." 

1. Primary union occurs rapidly and without the formation of matter, 
and leaves only a slight scar. It can be obtained in wounds with clean- 
cut edges, where the margins can be perfectly fitted together without 
anything intervening ; they must be kept perfectly quiet and protected 
from outward injury and from contact with external impurities. In this 
case, a material called lymph, which is practically the liquor sanguinis, 
is thrown out from the capillaries in the wound and acts like glue in 
sticking the sides of the wound together. The capillary vessels are 
then extended across the wound, and the circulation through it be- 
comes as complete as before the injury. The surgeon always seeks to 
approach as near primary union as possible, a wound uniting by this 
process completely in two or three days. Under old methods such a 
result was comparatively uncommon, but with the recognition of the 
functions of micro-organisms and the means of preventing their action, 
the surgeon is able to obtain primary union in the great majority of 
cases. 

2. Secondary union, second intention, or granulation, occurs slowly 
with the formation of matter and leaves a considerable scar. In this 
case (a) more or less of the tissues may have been lost, as in deep burns, 
ulcers, or wounds where more or less of the tissues have been torn out ; 
(&) the tissues adjoining the wound may be so injured as to be incapa- 
ble of new life, as in cases where the parts have been bruised or torn to 
a greater or less extent; (c) foreign matters, such as bits of cloth, or 
even clots of blood, may be interposed between the edges of the wound ; 
(d) the wound may not have been kept quiet ; (e) micro-organisms and 
dirt may have been allowed to enter the wound, causing decay of the 
tissues and the formation of matter. 

In these cases there is a vacancy which has to be filled up by new 
tissue. This is accompanied by the development in the wound of small 
red bodies like pin heads, called granulations, which are often covered 
to a greater or less extent with a thick, creamy fluid consisting of lymph 
with white blood corpuscles which have escaped from the capillary 
vessels. These granulations increase in number until the cavity of the 
wound is entirely filled. When this occurs, the skin at the edges of the 
wound begins to grow inward toward the centre, gradually diminishing 
the size of the opening until it is entirely covered by a fine red skin 
called scar tissue; as time passes, the unnecessary blood-vessels which 
at first are very numerous disappear and the scar loses its red tinge, often 
becoming whiter than the surrounding skin ; at the same time the scar 



BLEEDING I45 

becomes harder and contracts, so that if it be a large one the parts may 
be greatly drawn, as seen in the hand illustrated on page 130. While 
this is going on at the surface, the capillary blood-vessels find their way 
among the granulations, and the mass is organized into new tissue. 
Healing by second intention requires from a week to several months 
for its completion, according to the size of the wound and the favorable 
character of its surroundings. 

The excessive formation of granulations causing them to project 
above the surrounding skin is commonly known as " proud flesh." 
And where a wound refuses to heal, but breaks down with the forma- 
tion of granulations and the production of yellow or greenish yellow 
matter or pus, it is commonly said that the wound has " festered." 

The healing of wounds is modified by many conditions. A wound is 
apt to heal more rapidly in a healthy than in a delicate person. Youth 
is a great advantage, and habitual drinking a great disadvantage. A 
wound of the head heals, as a rule, more rapidly than one in any other 
part of the body, while one of the upper extremities closes more quickly 
than one of the lower. 

Poisoned wounds naturally heal badly, but these are reserved until 
they can be considered in the light of an acquaintance with the action 
and effects of poisons in the chapter devoted to that subject. 



CHAPTER XVIII 
BLEEDING 

Bleeding. — Definition : The escape of blood from its 

vessels. 
Varieties: (1) Arterial bleeding — the most dangerous. 

(2) Venous bleeding. (3) Capillary bleeding or 

oozing — the least dangerous. 
Causes: (1) Of arterial bleeding: a wound of an artery. 

(2) Of venous bleeding : a wound of a vein. (3) Of 

capillary bleeding or oozing : a wound involving only 

capillary vessels. 
Symptoms. A. Common to all: The appearance of 

blood, except in internal bleeding. Where severe 

and not promptly checked, the face is first pale and 



146 



EMERGENCIES AND ACCIDENTS 



then blue, the pulse sinks, the body becomes cold, the 
patient is dizzy and inclined to vomit, the eyes are 
dazzled, he hears noises, and finally becomes uncon- 
scious. 

B. Peculiar to each variety, (i) Of arterial 
bleeding : color bright red, and spurts in jets. (2) Of 
venous bleeding : color dark red or purplish, and wells 
out in a continuous stream. (3) Of capillary bleed- 
ing : slow oozing of blood, neither dark nor bright red. 
Treatment : 1. Of arterial bleeding. Summon a surgeon 
immediately ! (a) Expose the wound. (b) Make 
the patient lie down, and lift up the wounded part. 
(c) Press with the thumb or finger on or into the 
wound to temporarily stop the bleeding, (a 1 ) If the 
location of the large artery of the part is known (as 
per appended table), press upon it above the wound 
with the fingers, and later with a tourniquet ; if the 
location of the large artery is not known, surround 
the limb above the wound with a bandage drawn so 
tightly as to check the flow of blood, (e) Dress the 
wound with a compress and bandage. 



Point Wounded. 


Artery to JPart pressed 
Compress. Location. against . 

1 


Arm (see also J 
Forearm) ^j 


Runs over ist rib, back 
Subclavian. of middle of collar j First rib. 
j bone. 


Axillary. 


Runs along the arm 
side of the armpit, 
near the front of the 
arm. 


Arm bone 
(Humerus). 


Brachial. 


Runs along inner bor- 
der of the biceps 
muscle. 


Arm bone 
(Humerus). 


Armpit. 1 Subclavian. 


Runs over ist rib, back 

of middle of collar j First rib. 
bone. 


Cheek. Facial. 

1 


Runs over lower jaw T 

, • u Lower law 
bone one inch in , J 

front of its angle. 



BLEEDING 



147 



Point Wounded. 


Artery to 
Compress. 


Location. 


Part pressed 

AGAINST. 


Chest. 


Intercostal. 


Runs along inner mar- 
gin of upper or lower 
border of rib. 


Inner face of 
adjacent rib. 


1 Lower part 
Face < 


Facial. 


Runs over lower jaw 
bone one inch in 
front of its angle. 


Lower jaw 
bone. 


1 

TT 

[ Upper part 


Temporal. 


Runs along temporal 
bone just in front of 
the ear. 


Temporal 
bone. 


r 

Finger . . . • <( 

I 


Digital. 


Front of finger on 
either side. 


Phalanges. 


Palmar arches. 


Palm of hand. 


Metacarpus. 


Foot ^ 


Sole. . 


Posterior 
tibial. 


Runs about and below 
the external malleolus. 


Tarsus. 




Top. . 


Anterior 
tibial. 


Runs down middle of 
front of ankle. 


Instep 

(Tarsus). 


Forearm. 


Brachial. 


Middle of elbow and 
inner side of biceps. 


Arm bone 
(Humerus). 


Hand. 


Brachial. 


Middle of elbow and 
inner side of biceps. 


Arm bone 
(Humerus). 


Knee. 


Femoral. 


Middle of upper part 
of thigh. 


Hip bone. 


Leg (see also 
knee and thigh). 


Popliteal. 


Middle of back of 
knee. 


Thigh bone 
(Femur). 


Neck. 


Carotid. 


Front margin of ster- 
no-mastoid muscle 
from back of ear to 
sternum. 


Spine. 


Thigh. 


Femoral. 


Middle of groin. 


Hip bone. 



2. Of venous bleeding. Summon a surgeon imme- 
diately ! (a) Expose the wound, (b) Make the 
patient lie down, and lift up the wounded part. 
(c) Loosen any tight clothing between the wound 



I48 EMERGENCIES AND ACCIDENTS 

and the heart, (d) Press with thumb or finger on 
or into the wound to temporarily check the bleeding. 
(e) Prepare a thick compress and, removing the 
thumb or finger, bandage it firmly upon the wound. 

3. Of capillary bleeding. Apply water as hot as 
can be endured, or apply ice-cold water to the wound ; 
or simply bind a compress firmly upon the part. 

In no class of injuries is the prompt application of ample means of 
relief of so great value as in bleeding or hemorrhage. At least one-fifth 
of the deaths upon the battle-field in former days were due to bleeding, 
which might have been controlled by the prompt application of means 
with which every person might readily have been familiar. And in no 
class of cases is the aid applied more clearly a makeshift until the 
proper relief can be given by a surgeon. This is especially true of 
arterial bleeding, for the means already stated will permanently relieve 
capillary bleeding, and in the majority of cases venous bleeding will 
require no further treatment. 

The chief agent in permanently controlling hemorrhage is the clotting 
of the blood. It has been shown that when the movement of blood 
through the blood-vessels ceases, the fibrin appears in a network which 
entangles the corpuscles in its' meshes and produces a red elastic 
mass, a blood-clot. When there is an obstruction within a vessel, the 
current of the blood is interfered with, and a clot forms behind the 
obstruction. 

Where the force of the blood in a vessel is not very great, a clot 
formed may be a sufficient stay to the flow of blood. This force is 
called the blood pressure. In veins, it is only a quarter of a pound to 
the square inch. Consequently, when a flaccid vein is compressed 
together, and a clot firmly forms at the point of pressure, there is not 
force enough to drive this plug of clotted blood out of the vein and 
start the bleeding again. For this reason, simple pressure for a short 
time upon a bleeding vein is often sufficient of itself to check such 
bleeding. In the capillaries, the blood pressure is lighter still, so that 
clots form with great rapidity and promptly close these vessels when 
wounded. 

The blood pressure in the arteries, however, is from ten to sixteen 
times that in the veins, or four pounds to the square inch. Conse- 
quently, except in very small arteries, where the force has become 
greatly diminished, a clot formed during pressure will be promptly 
forced out of the vessels. 

There are other factors beside pressure which co-operate to assist in 
the formation of the clot in hemorrhage. The elasticity of the vessel 
diminishes the opening through which the blood escapes, and when a 



TREATMENT OF BLEEDING FROM ARTERIES I49 

large amount has been lost, ail the blood-vessels contract to meet the 
lessened demand upon them, while the weakened action of the heart 
itself causes less distention of the vessels. 

Moreover, when an artery is cut across, the inner coats contract and 
curl over inward sufficiently to entirely close small vessels and to not 
only diminish the size of the opening in large ones, but to afford a pro- 
jection inward upon which the fibrin may catch and form a clot. The 
projection of the inner coat also strengthens the clot. Obviously the 
inner coats cannot turn in unless the vessel is completely severed, so 
that a partially cut artery is more dangerous than one completely 
divided. Severe bleeding is thus sometimes checked like magic by 
the simple dash of a knife, completing the division, the inner coats, 
loosened, promptly turning back and closing the vessel. Vessels of 
considerable size may be closed in this way by being pulled and 
twisted, as sometimes occurs in the large torn wounds occurring in 
railroad and machinery accidents. The clot formed in a vessel, if not 
disturbed, becomes " organized." Blood-vessels push their way through 
it and send out white corpuscles which are transformed into tissue cells, 
and in time the entire clot is transformed into scar tissue. 

Treatment of Bleeding from Arteries. — In the treatment of arterial 
bleeding four classes of procedure are used : (a) twisting the vessel 
or "torsion," (b) tying or "ligaturing" the vessel, (c) position, and 
(d) pressure upon it in various ways. 

Twisting or "torsion" occurs naturally, as has been remarked in 
certain extensive lacerations, and it is often resorted to by surgeons ) 
particularly for the relief of bleeding from small arteries. With a small 
pair of forceps the cut end of the artery is grasped, pulled out, and 
twisted by a few turns of the forceps. The vessel is closed by the 
turning in of the inner coats. 

Tying or " ligaturing" the vessel consists in passing a suitable thread 
about it and tying up the bleeding end. This is the proper way to 
permanently close any artery, except very small ones. The materials 
used for this purpose are a fine quality of silk, prepared catgut, silver 
wire, and a large variety of similar materials. The material used in 
each case is called a ligature. 

To practise the methods of twisting and tying requires a knowledge 
of anatomy and surgery such as only a professional man can possess, 
and consequently these methods are to be used only by a surgeon. 

Position, however, is very simple in its application, and can be 
learned without difficulty. Where the body is sound, there is a perfect 
balance of the circulation, with no greater tendency for the blood to 
settle at the lower points than at the higher. If this balance is broken 
by a wound of an artery from which the blood flows out instead of 
returning to the system, the blood follows ordinary physical laws — it 
goes down more readily than it goes up. Consequently the elevation 



i5o 



EMERGENCIES AND ACCIDENTS 



of a bleeding part as high as possible above the heart, renders it more 
difficult for the blood to reach the wound and lessens the bleeding. In 
a wound of an artery of the foot, the patient should be laid on his 
back and the affected limb raised ; in a wound of the hand or upper 

extremity the patient 
should preferably be 
seated and the limb 
raised; similarly, a sit- 
ting or standing pos- 
ture would be advisa- 
ble in an injury of the 
head. 

Pressure is the most 
commonly applicable 
of the methods of 
temporarily checking 
bleeding, and can be 
used with the greatest 
readiness by laymen. 
Pressure may be exert- 
ed (a) directly upon a 
wound, (&) in a wound, 
plugging, (c) upon an 
entire limb above the 
wound, or (d) upon 
the vessel itself above 
the wound. 

(a) Where a wound 
is small, pressure may 
be made directly upon 
it either with a finger 
or by any other imple- 
ment used for exerting such pressure without entering the wound itself. 
I have seen a considerable number of cases where death has been 
averted in wounds of arteries by simply pressing firmly upon the 
wound with a thumb or finger. 

(b) Perhaps the most natural thing to do in case of a leak in any- 
thing is to put in a plug. A bleeding wound is a leak in the circulation, 
and the most natural thing to do in such a case is to put in a plug, 
and the most natural plug is .the finger. The plug acts by producing 
pressure on the surrounding parts, thus closing the vessels. It is held 
by many surgeons that this method alone is the best to be taught to 
troops in general for the emergencies of the battle-field. In 1859, a 
young Austrian soldier in whom the great artery of the thigh had been 
wounded, controlled the bleeding for four hours by firmly plugging the 













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Fig. 101. — Applying position in the treatment of bleed- 
ing from a wound of the arm. Pressure with the 
fingers is also being used. 



TREATMENT OF BLEEDING FROM ARTERIES 151 

wound with his thumb; if he had not done this, but a few moments 
would have sufficed to launch his soul into eternity. The hand, how- 
ever, is liable to tire, and this treatment may be made more permanent 
by substituting some clean, hard body covered with clean gauze, cloth, 
or paper and bound firmly into the wound by a bandage. It is well to 
have the plug so shaped as to not only fill the wound, but project 
beyond it, so that the encircling bandage will not constrict the person. 

In the upper and lower extremities a more efficient method of arrest- 
ing bleeding may be applied. This is closure of the bleeding artery by 
pressure upon it between the heart and the wound. 

(c) The most primitive method of pressing upon an artery above a 
wound is by tying something, such as a bandage torn from clothing, 
a triangular bandage, a handkerchief, or even a rope, tightly about the 
limb. But it is practically impossible to 
get enough pressure in this way, so, pick- 
ing up anything that may be at hand — a 
knife, a bayonet, a sword, a ramrod, or 
a revolver — and thrusting it under the 
bandage, by using it as a lever and twist- 
ing it about, it is possible to bind the limb 
so tightly as to entirely stop the circulation 
below it. Appliances for arresting the cir- 
culation in a limb by tightly compressing it 
in this way are called tourniquets. They 
may be improvised in this and other ways, 
and surgeons have them made expressly 
for the purpose. This particular extempo- 
rized tourniquet is often called the Spanish Fig. 102. — The Spanish wind- 
windlass. ' ass extemporized tourniquet. 

There are other methods of attaining 
this result more neatly by the application of elastic bands. If a bit of 
soft rubber tubing be at hand, nothing could be better ; it may be 
applied by tying it strongly about the limb. The same result may 
be accomplished by the use of an elastic suspender, if any bystander 
happens to have one to spare. Surgeon-General Esmarch of the 
Prussian Army has availed himself of this principle in devising a pair 
of suspenders expressly for this purpose. It is composed of a long 
strip of elastic webbing so arranged that the tags by which it is attached 
to the trousers can be readily removed, leaving a simple elastic bandage 
— an elastic tourniquet of the most improved pattern. 

If the bleeding is not too severe it may be possible to constrict the 
limb sufficiently by binding it firmly with a muslin roller bandage 
which may be made to shrink by saturating it with cold water. In the 
absence, however, of a rubber tube or an Esmarch's suspender, the 
twisted band or handkerchief would be better. 




152 EMERGENCIES AND ACCIDENTS 

The great disadvantage of this class of methods is the complete 
stoppage of the circulation in the entire portion of the limb below the 
tourniquet. Where continued for a considerable time, serious troubles, 
extending even to gangrene or death of the limb, may ensue. If the 
circulation then can be arrested in the wounded artery alone without 
affecting the circulation in the rest of the limb, the same result can be 
obtained with far less danger to the patient. 

(d) A readily available method of applying continuous pressure to a 
particular vessel is by applying a hard lump of some kind — a pebble or 
a cartridge, for instance — upon the vessel, and binding it on by a band- 
age tightened in the ways mentioned in the preceding class. This 
takes off the pressure on either side of the lump and allows a sufficient 
amount of blood to pass the obstruction to prevent strangulation of the 
limb. In Fig. 102 this method has been adopted in an extemporized 
tourniquet. 

The surgeon's tourniquet utilizes this" principle. It consists of a 
webbing strap with a buckle at one end, and attached to the strap 
a padded lump. The lump is applied over the artery 
and the strap is tightly buckled about the limb. The 
lump thus pressed upon the artery checks the circu- 
lation in the vessel. 

The tourniquet, however, is subject to the same ob- 
jection as the band drawn about a limb without twisting 
it — it is not tight enough. To obviate this difficulty, 

the screw tourniquet (Fig. 103) has been invented. It 
Fig. 103. — The ..... ,» ..1 .111 

is applied m exactlv the same wav as the other, but 
screw tourni- x r J J ' 

t when applied, it can be tightened to any degree by 

simply turning the screw. 

A tourniquet which can be quickly extemporized, but which can be 
applied only to the arm, is Volker's stick tourniquet (Fig. no). Two 
sticks from six to eight inches long, and from a half to three-quarters 
of an inch thick, are notched at either end ; one is then laid directly 
across the artery of the arm and the other is applied to the other side 
of the arm parallel to the former. The ends are then tied firmly to- 
gether. In this way the circulation in the great artery is arrested, while 
the collateral circulation of the small arteries running in the same direc- 
tion on either side is not disturbed. 

Another method of applying limited pressure consists in placing 
some hard body, such as a rod, a bottle, or even a stone, in the joint 
next above the bleeding point, and strongly bending the limb upon it 
(Figs. 112, 115). The limb may then be fastened in this position and 
so retained for a long time without damage. Where an extemporized 
method is necessitated, and this method can be used, as in the leg and 
in the upper extremity, it is probably the most useful; next to this, the 
twisted bandage with a lump. 




BLEEDING FROM ARTERIES OF THE HEAD 1 53 

In case of bleeding of any kind, presence of mind is of the greatest 
importance. It is rare that prepared appliances for arresting it are at 
hand. The mind must be capable of at once divining the proper action 
and of instantly executing it. The lump may be composed not only 
of a stone, but of a cartridge, a cork, a ball of any kind, a marble, a 
hard knot in a bandage or handkerchief, a small spool, or a firmly 
rolled mass of cloth, or even a strongly crumpled mass of paper. The 
band may be formed not only of a triangular bandage cravat, twisted or 
flat, but of a handkerchief, a roller bandage, strips of clothing, ropes, 
cords, belt, or any soft tough strip which can be firmly tied about a 
limb. On the battle-field arms, or fragments of arms, w r ill be available 
for twisting the band, and in civil life sticks of various kinds, parasols 
and umbrellas, rulers and bottles, pocket knives and scissors, keys and 
canes, and innumerable substitutes which will be found at various 
places. The mind should be familiar with this fact, and should be pre- 
pared to adapt neighboring articles to the present emergency. 

Bleeding from Arteries of the Head. — Owing to the fact 
that the entire scalp is underlaid by a plate of bone, there is 
no difficulty in deciding where to exert pressure in order to 
check bleeding there. Press directly down upon the scalp 
near the edge of the wound on the side from which the 
bleeding proceeds. The artery will not always be found at 
once, owing to its small size, but two or three trials will lo- 
cate it without difficulty. Permanent compression may be 
exerted by laying a hard pad. extemporized from any available 
material, upon the point of pressure, and 
holding it in place with a bandage formed 
also of the most convenient substance. 
The shape of the head makes it some- 
times a little difficult to tie on the band- 
age so that it will hold the pad firmly in 
place, but perseverance and a little inge- 
nuity, particularly when reinforced by 
previous practice on the head of a friend, 

1 ... . l . . . . . ' Fig. 104. — Pressure with 

will always be rewarded with success. the thumb( contro i| ing 

In Case Of a WOUnd Of either temple, bleeding in the temple. 

the temporal artery below the wound 

should be compressed upon the bone (Fig. 104). It will be 
remembered that this artery runs up in front of the ear, and 
divides into two branches. Permanent compression may be 




154 



EMERGENCIES AND ACCIDENTS 




Fig. 105. — Pressure with 
the thumb, controlling 
bleeding from the face. 



applied by means of the knotted turn of the roller bandage 
(page 1 06), a suitable pad being held in place under the knot. 
The arteries of the face are mostly branches of the facial, 
which crosses the lower jaw about an inch in front of the 
angle of the jaw. where its pulse can be readily felt. 
(1) Bleeding can then be controlled by pressing the artery 
clown firmly upon the jaw bone with the 
thumb, or, if it be desirable to make it 
permanent, a suitable pad may be ap- 
plied instead of the thumb, and bound 
firmly in place by a bandage passing 
under the lower jaw and over the top 
of the head. (2) Temporary control of 
the bleeding may also be obtained in 
wounds of the cheeks or lips by passing 
the thumb into the mouth, and, grasping 
the cheek just below the wound, between the thumb and 
fingers, pressing the artery between them. 

Bleeding from Arteries of the Neck. — When the large 
vessels of the neck are severed, as in " cut throat " or other 
wounds in that region, the utmost quickness in checking the 
bleeding is necessary to save life. A moment's delay may be 
fatal, for the blood rushes from 
these vessels in tumultuous tor- 
rents. All of the carotid arte- 
ries and most of their branches 
are large and important vessels. 
It should be remembered that 
the line of the carotid arteries 
extends from the mastoid pro- 
cess behind the ear down to the 
edge of the top of the breast 
bone. Without an instant's de- 
lay, in a wound of this kind, 
the vessel should be promptly 
pressed back upon the spine 
with the thumb, and held there until the assistance of a 
surgeon is brought. No attempt should be made to substi- 
tute a pad for the finger, for nothing else can be trusted. 




Fig. 106. — Pressure with the thumb, 
controlling bleeding in the neck. 



BLEEDING FROM ARTERIES OF THE ARM 1 55 




Fig. 107, — Pressure back of the collar 
bone, controlling bleeding from the 
upper extremity. 



As the hemorrhage in the neck may proceed from the 

veins, and as this is almost equal in danger to that from 

arteries, it may perhaps be best in all cases to apply the 

pressure directly in the wound. It should be remembered, 

however, that there must be no 

hesitation or delay in applying 

the treatment, whatever it is. 
Bleeding from Arteries of the 

Upper Extremity. — The course 

of the great artery of the upper 

extremity may be remembered 

(Fig. 113) as arising out of the 

chest : it runs over the first rib 

just under the middle of the 

collar bone (subclavian artery), 

passes thence to the inner side 

of the arm (axillary artery), 

running do along the inner 

edge of the biceps muscle 

(brachial artery) to the middle of the elbow, just below 

which it divides into two main branches (radial and ulnar 

arteries), which course down either anterior edge of the 

forearm, and form two arches in the palm of the hand 
(palmar arches) . 

If the injury be in the armpit^ the 
artery must be compressed either under 
the collar bone or in the wound itself. 
(1) To compress the artery under the 
collar bone, the thumb should be thrust 
strongly down behind the middle of the 
bone until the pulsation of the subclavian 

Fig 108. — The handle of artery is felt, when the pressure should 

a door key padded for be cont i nuec l unt jl the blood CeaSCS to 
pressure under the col- n _. , , 

)ar bone flow. The subclavian is not easy to 

compress, and this manoeuvre should be 

thoroughly practised upon one's friends. If a surgeon can 

be got within a reasonable time, the pressure of the thumb 

should be maintained until his arrival. If, however, some 




156 



EMERGENCIES AND ACCIDENTS 




considerable time must elapse, the thumb, even of the strong- 
est man, will become tired and powerless, and a substitute for 
it will be desirable. In this case the handle of a key or any 
similar article, suitably padded, may be slipped down under 
the thumb and applied upon the artery. (2) Pressure in the 
wound is performed by pushing the thumb forcibly into it, 
and pressing the parts strongly against the arm bone. 

If the injury be in the arm, the bleeding may be checked 
by compression of the subclavian, as described above, 
and by pressure upon the brachial 
artery in the wound itself or in the 
arm. Aside from pressure in the 
wound itself, (1) pressure of the ar- 
tery with the ringers against the arm 
bone is the most readily applied. 
The arm should always be raised 
in cases of this kind, as shown in 
Fig. 101. 

(2) Volker's stick tourniquet (Fig. 
1 10) — composed of two sticks six to 
eight inches long, a half to three 
quarters of an inch thick, and notched 
at the ends, which are bound together 
by any available material — is an excellent means of exerting 
permanent pressure upon the artery of the arm. 

(3) A tourniquet extemporized 
from a handkerchief, a bandage, 
or any similar article, as described 
on page 151, — particularly when 
supplied with a pad to press 
directly upon the artery (Fig. 
102), — is of the utmost value, 
and ^ perhaps the most valuable 
extemporized means of checking 
bleeding from the arm. 

(4) Where a screw tourniquet can be had, it should be 
used in preference to the other appliances, provided the 
artery can be located readily. 



F\g.\09. — Pressure upon the 
artery above the wound, 
controlling bleeding from 
the arm. 




Fig. 110. — Volker's stick tourniquet 
for pressure upon the artery of the 
arm. 



BLEEDING FROM ARTERIES OF THE ARM 1 57 




The foregoing demand some knowledge of the course of 
the vessels, and, while they are the best for the patient, yet 
it often occurs that those who are obliged to render first aid 
are not at all familiar with anatomy. In this case, methods 
not demanding such knowledge may be used, but it should 
not be forgotten that where a limb is tightly surrounded by 
any band, it is likely to become strangled 
and permanently injured. Still, where 
a life is at stake a certain amount of 
risk must be taken. 

(5) Rubber tubing, elastic bandages, 
and the like are available here as well 
as in other extremities, and can be 
used when obtainable with the greatest 
advantage. 

(6) A rod of wood, a base or billiard 
ball, and other articles of the kind, 
when pushed strongly into the armpit, 
form an excellent means of checking 
bleeding from the arm, if the limb be 
strongly bound down to the side, so as to compress the artery 
closely against the bone (Fig. 112). 

In case of a wound at the elbow, all the procedures pre- 
scribed for the arm are to be applied. 

If an artery in the forear//i be wounded, in addition to 
pressure in the wound itself, (1) the methods 
employed for the arm and elbow may be 
used ; for if the arm be so bound that the 
blood cannot pass below the arm or elbow, 
it certainly cannot issue from the forearm. 
(2) A readily applied method consists in 
Fig. 112. — Pressure placing a hard body, such as a cane, a small 
upon the artery of ] 30tt i e a roc j f rom a tree , or any similar article 

the arm by a ruler ... 

in the armpit. m ^ ie elbow, and strongly bending it upon 
it : this may be made permanent by band- 
aging the forearm strongly to the arm (Fig. 115)- 

If the injury be low down, particularly in the wrist, in ad- 
dition to methods in the arm and elbow, bleeding may be 



Fig. ill. — The screw tourni- 
quet applied for control- 
ling bleeding of the arm. 




I58 EMERGENCIES AND ACCIDENTS 

checked by pressing the wounded artery strongly upon the 
forearm bones. However, in this case, it is better to apply 
the pressure in the arm or elbow ; for, on account of the large 
palmar arches, the blood will spurt out of both ends of the 
divided artery. Pressing the artery on both sides of the 
wound, however, will arrest the bleeding and, as well, pressure 
in the wound itself. 

In the palm of the hand, the same condition exists, and 
pressure must be exerted either in the arm or elbow, or both 
forearm arteries must be compressed. Bleeding here can, 
however, often be controlled by -grasping some hard object, 
like a billiard ball, or a smooth stone, or, in emergency, even 
an apple or a potato, in the palm : the pressure may be made 
permanent by bandaging the hand strongly in this position. 

Bleeding from the fingers can always be controlled by 
pressure in the wound or above it, with the finger, or any 
other means of applying it. 

Bleeding from the Arteries of the Body. — In bleeding 
wounds of the chest and abdomen, pressure should always be 
exerted in the wound itself, with a single exception. The 
exception is the case of a wound of one of the intercostal 
arteries, running along the edges of the ribs, and rather inside 
of the chest, so that the pressure upon the bone must be 
exerted from within outwards. To effect this, make up a 
little roll, preferably of antiseptic gauze, or of any other clean 
cloth, and tie it firmly with a string ; work the roll through 
the wound into the chest, and then pull upon the string 
forcibly enough to press the roll against the bleeding vessel 
upon the rib. 

In other wounds of the trunk, the bleeding should be con- 
trolled by pressure in the wound, with the fingers temporarily, 
or with a hard lump or pad and bandage permanently. 

Bleeding from Arteries of the Lower Extremity. — The 
arrangement of the arteries of the lower extremity is very 
similar to that of the upper extremity. A single large vessel 
(femoral artery} passes into the thigh, over the front of 
the hip bone, at the middle of the groin ; it runs down the 
middle of the thigh, and in the lower portion passes through 



BLEEDING FROM THE ARTERIES 



159 




Fig. 113. 



-The arteries of the body, showing their relations to the bones at the 
points where pressure is to be made to control Needing. 



i6o 



EMERGENCIES AND ACCIDENTS 



to the back of the thigh, where it runs behind the knee 
(popliteal artery) , and, just below the joint, separates into two 
arteries, one of which runs down, skirting the lower edge of 
the internal malleolus, at the inner face of the ankle, to supply 
the sole of the foot (posterior tibial artery) , and the other 
down the front of the ankle, to the top of the foot {anterior 
tibial artery) . The artery is found near the surface in the 
groin and the upper part of the thigh, the back of the knee, 
the outer side of the heel, and in the front of the ankle. 
These points are naturally the proper localities for the appli- 
cation of pressure to check bleeding. 

In case of bleeding from the arteries of the thigh, (i) the 
great femoral artery must be compressed in the middle of the 
groin, against the hip bone. Wounds of this artery are 
rapidly mortal unless immediate treatment is applied. Delay 
is fatal! Like the subclavian, it is very difficult to compress, 
and both thumbs should be applied 
upon it with all the force possible. 
If the arrival of a surgeon — who 
should be summoned immediately — 
is delayed, a substitute should be pro- 
vided in a tourniquet, extemporized or 
prepared. (2) The Spanish windlass 
(Fig. 102) — a lump, suitably padded, 
being applied directly upon the artery 
— may be used. (3) An elastic band 
or a rubber tube is useful here as in 
other places. A screw tourniquet, with 
the pad upon the artery, is of service. 
(4) A pole, extending from the ceiling 
to the bed, may be so arranged — one 
end pressing upon the ceiling' and the 
other upon the artery — as to hold the 
flow of blood in check. (5) Compression by the finger in 
the wound is here of value as well as elsewhere, and the only 
objection to it is the liability to soil the wound with matters 
clinging to the thumb. 

Bleeding from the back of the knee or ha?n proceeds from 




Fig. 114. — Pressure upon the 
artery of the thigh by the 
thumbs, to control bleed- 
ing below it. 




BLEEDING FROM ARTERIES OF THE LEG l6l 

the popliteal artery, a continuation of the femoral, and it 
must be controlled by precisely the same manoeuvres as 
bleeding from the thigh, — compression of the femoral artery 
in the middle of the groin, or pressure in the wound. 

If the injury involve an arterial wound of the leg, (i) the 
bleeding may be controlled in the same way as that of the 
thigh and ham. (2) It may be checked for a short time by 
bending the leg strongly back on the thigh, but this position 
cannot be maintained long on account of the resulting weari- 
ness to the patient. (3) But the appli- 
cation in the ham of a pad, such as an 
ordinary base ball, or an apple, potato, 
or even a stone of a similar size and 
shape, with the leg strongly bent upon 
it, will control the bleeding without the 
insufferable weariness. A rod, such as 
a cane or umbrella, a branch from a 
tree, or anything of the kind should be Fig. 115. — Pressure by a pad 
passed under it, and supported strongly in the hollow of the knee 

. x , , 1 • , , with a rod, to hold it in 

upon it by a bandage passing about place) controlling bleed . 
the bent limb. (4) The finger in the ing in the leg and below. 
wound may be used here also, subject 
to the objection of being a possible conveyer of infection. 

The foot is supplied by three arteries, all of which, like 
those of the hand, communicate so freely with one another, 
that, as in the hand, it is usually best to apply the pressure 
directly upon the wound. This may be done first by the 
thumb, and later by a suitably prepared pad and bandage. 
The foot is peculiarly adapted to treatment by elevation, the 
patient lying on his back ; and it is well to apply all treat- 
ment with the foot lifted up. Bleeding from a wound of the 
sole of the foot may usually be controlled by pressure upon 
the posterior tibial artery, just below the internal malleolus, 
applied in the usual way. If the bleeding is not checked, 
pressure added upon the anterior tibial in front of the ankle 
will generally stop the bleeding ; and if this is not successful, 
the peroneal, a small artery on the outer ankle, may also be 
subjected to pressure. This will control the bleeding in the 



l62 



EMERGENCIES AND ACCIDENTS 



most extreme cases. If the back of the foot be the seat cf 
injury, the anterior tibial in front of the ankle should be 
compressed first, and then the others as needed (Fig. 116). 

Bleeding from Wounds of Veins. — Venous bleeding in 
general is comparatively free from danger, although a wound 
of one of the great veins of the neck {jugulars) in *• cut 
throat" is a condition to be feared nearly as much as an 
arterial wound. Other large veins, especially in the extremi- 
ties, accompany the arteries, and although they are often 
injured at the same time, the veins may be divided alone. 
Not uncommonly, superficial veins, particularly in the leg, 
become greatly enlarged, and form twisted, knotted ridges 




Fig. 116. — Pressure at the inner side of the ankle, controlling bleeding in the foot. 

under the skin : these are varicose veins. Injuries to them 
are equal in danger to those of veins normally greater in 
size. 

It will be remembered that veins are provided with frequent 
valves, which prevent the return of blood from the heart. 
In large veins, however, it often happens that the valves are 
absent, or incompetent, so that in case of a venous wound, 



BLEEDING FROM VEINS AND CAPILLARIES 1 63 

the blood will flow from both ends of the divided vessel. In 
varicose veins the valves are, by disease, rendered useless, so 
that in case of a wound or rupture the blood will escape freely 
from both directions. 

It will also be recalled that veins are very flaccid and easily 
compressed, so that but little pressure is needed to control 
bleeding from these vessels. 

To control bleeding from any vein, then, a method which 
would compress both ends at the same time is desirable ; and 
this is found in the method of direct pressure in the wound 
itself. It is accomplished by pressing firmly with the thumb 
at first, in order to hold the bleeding in check temporarily. 
Then, a suitable pad having been provided', it should be 
bound upon the wound firmly enough to restrain the bleed- 
ing permanently. 

Any tight article of clothing which binds the body between 
the injury and the heart — since it may interfere with the 
return of the blood — should be loosened. Garters should 
be removed, belts should be unfastened, and collars should 
be taken ofT, so as to allow the blood free flow toward the 
heart. 

And the application of elevation to all venous wounds 
should not be forgotten. 

Bleeding from wounds of veins may be controlled, where the valves 
are intact, by simple pressure upon the vein below the wound — be- 
tween the capillaries and the wound. This method of treatment is 
advised by many authorities, and may be used with advantage where it 
is absolutely impossible to find clean materials for a pad — which will be 
rarely. Indeed, pads above and below the wound may be used to con- 
trol vein injuries where the blood comes from both ends of the vessel. 

Bleeding from Wounds of the Capillaries. — This is the 
variety of bleeding most frequently seen when blood, not so 
bright as that in the arteries nor so dark as that in the veins, 
oozes from a small wound. Capillaries are so generally pres- 
ent in the tissues that capillary bleeding is present in all 
wounds, even though injury of larger vessels may mask it. 
It may vary in severity, sometimes oozing very slowly, as 
when a bit of scarf skin is scraped ofT. and again, flowing in 



164 EMERGENCIES AND ACCIDENTS 

a considerable stream, as when a finger has been cut with a 
pocket knife. It will be found in scratches, pricks, and slight 
cuts of all kinds, whether from the careless use of the razor. 
a slip of a knife, accidental contact with broken glass, or 
similar accidents. 

The treatment is simple. Mere exposure to the air for a 
few moments, with no other treatment, will often see capillary 
bleeding completely checked. The exposure causes contrac- 
tion of the open vessels and clotting of the blood, which, 
together with the small amount of blood pressure, renders it 
possible for plugs of blood clot to quickly fill them. 

Hot water, as hot as it can be borne by the patient, is one 
of the most valuable and efficient means of controlling cap- 
illary bleeding, and is often used by surgeons to diminish 
the flow of blood during operations. It may be applied by 
squeezing out a sponge or a mass of cloth, as shown in con- 
nection with the cleansing of wounds (page 136). 

Extremely cold water has a similar effect to hot, although it 
is not quite as satisfactory in its action. Ice or ice water may 
be used with advantage for the relief of capillary bleeding. 

The pressure of a pad directly upon the bleeding part is 
also of advantage in controlling capillary bleeding. In this 
case the pad may well be wet with hot or cold water before 
binding it tightly in place. 

The use of styptics, such as perchloride of iron, Monsel's solution, 
tannic acid, styptic cotton, and the like, should be absolutely discouraged 
in any kind of bleeding, on account of their interference with the process 
of healing. The application of cobwebs or tobacco to bleeding surfaces 
is still more objectionable, — the first, on account of its liability to intro- 
duce not only dirt but disease-producing germs; and the second, on 
account of the danger of absorption of its poisonous constituent, nico- 
tine. If a styptic is really needed, a little alum dissolved in clean water 
may be used, particularly in bleeding from the mouth and nose. 

Spitting of Blood. — The discharge of blood from the 
mouth is commonly known by this name, although it may be 
due to a number of different causes, and proceed from a num- 
ber of sources. 

(a) Blood may come from the mucous membrane of the 



SPITTING OF BLOOD 165 

nose, and run down through the posterior opening of the nose 
into the mouth. In this case, the blood can be felt passing 
down into the mouth : and the treatment is the same as that 
for nosebleed. 

(d) Blood may come from the mucous membrane of the 
mouth, and particularly from the gums. Slight bleeding of 
this kind is of no moment, and will quickly recover without 
treatment. At other times it continues so long and is so 
abundant as to be annoying in the extreme. In this case, 
filling the mouth with fluid as hot as can be borne, thus 
bringing it in contact with every bleeding point, is of advan- 
tage. Hot coffee or tea are as good as hot water, and are 
more agreeable to some. Pieces of ice in the mouth are also 
useful. Here alum can be used with advantage in a strong 
solution washed about the mouth. In the absence of alum. 
a strong solution of salt in water is of value, used in the same 
way. In case of bleeding from the cavity left after the ex- 
traction of a tooth, a plug of cotton saturated with either of 
the two latter agents may be of advantage. 

Severe bleeding from the tongue or the inner surface of 
the cheek may require to be controlled by pressure, which is 
best applied by pressing a pad directly upon the bleeding 
point with one finger, and supporting the opposite side with 
a thumb or another finger. 

(V) Blood may come from the throat, and in this case either 
the windpipe or the gullet may be injured. It is not prac- 
ticable to apply pressure directly here, and the treatment 
should be confined to placing the patient in a lying-down 
position, and keeping him as quiet as possible. If the bleed- 
ing is considerable, and ice is obtainable, he should be made 
to swallow a considerable quantity pounded into pieces the 
size of a pea. 

(d) Bleeding from the lungs. •• pulmonary hemorrhage." is 
caused by the breaking of a vessel in the lungs, and is accom- 
panied by coughing, with rattling in the chest, while the blood 
itself is frothy and bright red. The break in the vessel is 
usually produced by the advance of consumption, although it 
may be due to a splinter from a broken bone sticking into 
the lung, or a wound due to any other cause. 



l66 EMERGENCIES AND ACCIDENTS 

A physician should be called at once. While awaiting his 
arrival, the patient should immediately be made to lie down, 
with pillows or their equivalent so placed as to slightly elevate 
the head and shoulders. Finely chopped ice should be eaten 
in this case also. If a teaspoonful or so of salt can be eaten 
with it occasionally, so much the better, or the salt may be 
dissolved in a little cold water, which may then be drank. 
The patient should be kept absolutely quiet, and while he 
should not be placed in danger of taking cold, the room 
should be kept very cool. If available, a quarter of a tea- 
spoonful of spirits of turpentine may be given in a little cold 
milk every two or three hours. The patient should be kept 
in a darkened room, and no persons not essential for his care 
should be admitted, while every effort should be made to 
have as little noise as possible. 

(e) Bleeding in the stomach is due to the breaking of 
a vessel in the stomach, and may be caused by an ulcer 
eating into the vessel, or other causes which might produce 
rupture of a vessel in any part of the body. Blood from 
the stomach is vomited up, is usually clotted and never 
frothy, is of a color extending from dark red to black, and 
may be mingled with masses of food. It should be remem- 
bered that vomiting of blood is not invariably caused by 
bleeding into the stomach. Blood from the mouth, or even 
the nose, may be swallowed and thrown up again. 

The proper treatment in this case, after sending for a phy- 
sician, is to make the patient lie down, with the head and 
shoulders slightly raised ; keep him absolutely quiet, and 
feed him with chopped ice, and give him turpentine in 
quarter-teaspoonful doses in a little cold milk every two or 
three hours. 

Nosebleed, " nasal hemorrhage," proceeds from the vessels 
of the mucous membrane of the nose, and, while it is usually 
of no moment, and stops spontaneously, it may be so severe 
and prolonged as to be very alarming. Usually, however, it 
need not be the source of the least anxiety, for a sufficient 
clot will readily form to hold it in check. If it be obstinate, 
cold water, or solutions of salt or alum, or even vinegar, may 



NOSEBLEED AND INTERNAL BLEEDING 167 

be snuffed or syringed into the bleeding nostril. The arms 
may be lifted above the head — a procedure which is said to 
have been eminently successful. These having failed, the 
nostril must be plugged. The plug is best made of a long 
strip of cheese-cloth or old linen or muslin, a half an inch 
wide. With a pencil or a penholder, one end should be 
pushed into the nose as far as it will go ; the rest of the strip 
should then be pushed in firmly and packed tightly, the end 
being allowed to hang out of the nose. To remove the plug, 
the strip may readily be drawn out by this protruding end. 
If the blood, dammed up in front, begins to find its way into 
the mouth through the posterior opening of the nostril, the 
plug has not been packed tightly enough behind, and it 
should be drawn out and packed in again. This plug should 
be kept in place for several hours, and when drawn out, the 
greatest care should be employed to prevent a renewal of the 
bleeding by too much force. If the dried blood has caused 
it to stick, it should not be pulled forcibly away, but should 
be loosened by warm water or oil. 

Internal Bleeding in General. — In internal bleeding, the 
blood may escape into a closed cavity, such as the abdomen 
or cranium, and present no external evidences, or it may 
escape through an opening in the cavity, artificial or natural, 
as through a wound in the chest or abdomen, or through the 
gullet or windpipe, from the lungs or stomach. Bleeding 
into the cranium is most often caused by rupture of one of 
the minute arteries of the brain, and constitutes the accident 
known as apoplexy, which will be treated further in the 
chapter on Fainting. Bleeding into the chest, where the 
lung is not wounded, may fill up the cavity with blood, and 
press upon the lung so much as to seriously interfere with 
breathing. In any case, the paleness, small pulse, chill of 
the body, dizziness, and inclination to vomit, and other symp- 
toms of bleeding are present, and demand the treatment 
due to shock in all cases, — a lying-down position, warmth in 
hot-water bottles to counteract the chill, and hot coffee or 
tea internally, except in case of bleeding from the lung or 
stomach. 



168 EMERGENCIES AND ACCIDENTS 

Secondary Bleeding, or "recurrent hemorrhage," not as common 
now as before the advent of the antiseptic era in surgery, may be due 
to the renewal of strength in the circulation after severe bleeding, or to 
the ulceration of a blood-vessel. In the former case, the bleeding 
comes on within a few hours, but the latter may occur after several 
weeks. Where the bleeding is slight, it may be controlled by the ad- 
dition of a little pressure upon the wound. If this is not sufficient, the 
dressing must be renewed, and the treatment proper to a fresh wound 
applied with great promptness. In severe secondary bleeding a surgeon 
should be summoned without delay. 

Special Susceptibility to Bleeding is sometimes found in persons 
who are surgically known as "bleeders." In these persons, the least 
scratch produces alarming bleeding, and the extraction of a tooth has 
been known to result in death, by bleeding from the cavity. In such 
persons, the greatest care should be taken to avoid the occurrence of 
bleeding of any kind, and where the accident does occur, no delay 
should be made in applying temporary treatment and summoning a 
surgeon. 



CHAPTER XIX 

SPRAINS AND DISLOCATIONS 

Sprains. — Definition : A violent twist or strain of the soft 
parts about a joint. 

Causes : Any accident which may cause a twist or strain 
of a joint. 

Sympto?ns : Great pain at the joint, following an unusual 
strain, such as a wrench or twist. Swelling about the 
joint rapidly follows. Discoloration similar to that 
produced by a bruise is apt to appear in the swelling. 
The bones are in their proper place, as seen by com- 
parison with the same joint on the opposite side. The 
absence of signs of broken bones shows that that acci- 
dent has not occurred. 

Treatment : Place the joint in a position where it will 
have complete rest. Apply water as hot as can be 
borne freely about the joint, gradually increasing the 
heat, as long as it can be endured. Continue this for 



SPRAINS AND DISLOCATIONS 169 

half an hour, and then substitute ordinary hot, moist 
fomentations for another half-hour, and finally put the 
joint up in a wet bandage, keeping it well elevated. 
Consult a surgeon. 

This affection invariably follows an accident. A man walking rap- 
idly, steps into a hole, and is thrown down, with a turn of his body. 
His foot being caught, the twist comes upon his ankle, and he has a 
sprain of the ankle, where this accident is by far the more frequently 
situated. Next in frequency comes the wrist, which is sprained by a 
fall, the hands being thrown out to catch the body, or in other ways. 
Other joints — the hip, shoulder, elbow, knee, etc. — are less frequently 
affected. , 

The injury in a sprain depends to a great extent upon the inability 
of the ligaments to stretch when they are subjected to a strain. When 
a joint is wrenched or strongly pulled upon, the strain comes upon the 
ligaments, and they become bruised, and even torn. A small bit of 
the adjacent bone may even be torn off in a sprain. The same violence 
which has acted upon the ligaments is likely to act also upon the neigh- 
boring soft parts, the muscles, and even the skin. While in extreme 
cases, the bone and periosteum themselves are bruised. 

It is evident that a sprain is apt to be a much more serious accident 
than would appear at first. While there are slight sprains which will 
require no attention, it should not be forgotten that severe sprains are 
injuries of great importance, and that permanent lameness has often 
followed a failure to give such an injury proper immediate care. 

In sprains of the ankle, the entire foot and ankle should be plunged 
into water as hot as could be borne, and the heat should be gradually 
raised as high as possible without passing the endurance of the patient. 
In sprains of the wrist or fingers, the same course may be adopted. 
After continuing this from a half an hour to an hour, the part should be 
supported in an elevated position, — the foot placed on a chair, and the 
wrist in a sling, — and hot, wet cloths kept wrapped about it. After 
the first acute pain has subsided, in a day or so begin gently moving 
the joint, and rubbing it with soap liniment, oil, or vaseline ; and 
kneading it gently at intervals. 

Bones out of Joint. — Definition: The displacement of 
the end of a bone from its proper contact with another 
— a dislocation . 
Causes : Those of sprain in a more violent form ; a sud- 
den wrench or twist sufficient to tear the ligaments, and 
allow the bone to slip out of place. 



170 



EMERGENCIES AND ACCIDENTS 



Symptoms : (1) The shape of the joint is changed. To 
ascertain this, the joint should be compared with that 
of the opposite side. (2) The limb is longer or shorter 
than that of the opposite side. (3) The relation of 
the limb to adjacent parts is changed. (4) Pain at 
the joint. (5) The patient cannot move the limb : 
this is an important factor in distinguishing a dislo- 
cated from a broken bone. 

Treatment : Send for a surgeon instantly. While await- 
ing his arrival, place the patient in as comfortable a 
position as possible, supporting the injured side by 
pillows and pads in its new attitude, and surround the 



joint with hot moist 
In most varieties of 
although delay in 





Fig. 117. — Method of replacing a 
dislocated lower jaw. The upper 
diagram shows the relation of 
the bones in the dislocation. 



fomentations, 
dislocation, 
treatment is 
harmful, un- 
educated 
handling is 
still more so ; 
consequently 
they had bet- 
ter be left untouched. 

Where, however, the services 
of a surgeon cannot be obtained 
for several hours, an attempt may 
be made to correct dislocations 
of the fingers or toes, the lower 
jaw, and the shoulder. 

Dislocations of fingers can be re- 
duced by strongly pulling on the finger, 
at the same time pushing the tip of the 
finger backward, if the end of the bone 
has slipped on to the back of its neigh- 
bor, or forward, if it has slipped on to 
the palmar face ; and also pushing the 
dislocated end into its place. When 
returned to its proper place, the finger 
may be wound with a strip of sticking- 
plaster as wide as the finger is long. 



BONES OUT OF JOINT I7I 

Some dislocations of the finger are very difficult to reduce^ and if suc- 
cess is not promptly attained by the method suggested here, the injury 
should not be irritated by further efforts. Dislocations of the thumb 
are very difficult to manage, and should be let alone. 

Dislocation of the lower jaw occurs as a consequence of extreme 
yawning or laughing, and is a most embarrassing accident to the victim, 
who remains with his mouth fixed widely open, with the saliva dripping 
from its corners, and deprived of the power of distinct speech. In this 
case, wind a handkerchief thickly about both your thumbs, padding 
them sufficiently to prevent injury by the sudden closing of the mouth 
when reduced. Place one thumb on to the lower jaw on each side as 
far back as possible, and grasp the jaw between it and the fingers with- 
out. Then press firmly downward and backward, when the jaw will be 
felt to move quickly into place. The thumbs should be drawn out from 
between the teeth with the greatest quickness, or they will be in danger 
of being crushed between the jaws when the muscles, tired by their 
enforced extension, rapidly and involuntarily contract. Once replaced, 
the jaw should be kept in position for a while by a handkerchief, bound 
about the point of the chin and the top of the head, or a four-tailed 
bandage would answer better still. 




Fig. 118. — Method of replacing a dislocated shoulder, by the foot in the armpit. 

Dislocation of the Shoulder. — In this injury, in addition to the signs 
of dislocation mentioned in the beginning of this chapter, the elbow 
usually projects from the side, and the upper arm appears to be slightly 
lengthened. The arm cannot be moved, and there is great pain in the 
joint. 

Make the patient lie down on a bed or couch, or on the ground — 
failing a better place. Roll a pad out of several handkerchiefs, or 
something else that will make a pad of about that size, and place it 



172 EMERGENCIES AND ACCIDENTS 

in the armpit, to avoid injury, by your foot. Then seat yourself by 
his side, with your foot in a direction opposite to his ; remove the 
shoe from your foot nearest to him ; put your foot in his armpit ; grasp 
his dislocated arm in both your hands, and, pushing your foot in his 
armpit, pull strongly on the arm, at the same time swinging it toward 
his body. A snap will usually be felt, and the bone will be found to 
have returned to its place. If one or two attempts at reduction by this 
method fail, further efforts should be left to the surgeon, who should 
have been summoned in any case. After the dislocation is reduced, 
the arm should be bandaged firmly to the side for a day or two, in order 
to give the torn and bruised parts an opportunity to recover. 



CHAPTER XX 

BROKEN BONES 

Fracture. — Definition : A break in a bone. 

Varieties : 1 . Simple, when the bone is broken in a 
single place, and there is no opening to the surface of 
the body. 

2. Comminuted, when the bone is broken into 
several pieces. A comminuted fracture may also be 
compound. 

3. Compound, when, in addition to the break in the 
bone, there is an opening through the soft parts to the 
surface of the body. A compound fracture may also 
be comminuted. 

Causes : 1 . Direct violence, where some powerful force 
strikes upon the body at a certain point, breaking the 
bone there. 

2. Indirect violence, where powerful forces strike 
upon the ends of a bone, causing it to break between 
them. 
Symptoms : 1 . A violent accident of some kind, involv- 
ing either a fall of the patient or of some heavy body 
upon him. 

2. Pain at a fixed point — the place of the fracture. 



BROKEN BONES 1 73 

3. A crack may have been felt or heard by the 
patient when the accident occurred. 

4. The limb can be bent at that point, when it was 
immovable before. 

5. The broken ends may be displaced by the action 
of the muscles, the ends having slipped past one an- 
other, in which case a limb would be shortened. 

6. Upon gently feeling of the part, some irregularity 
of the bone will be felt at the painful point. 

7. A crackling, called -crepitus*" by surgeons, may 
be felt when the bone is firmly grasped above and 
below the painful point, and gently moved so as to 
cause the ends to rub upon one another. 

Treatment : 1. Simple Fracture, (a) If a surgeon 
can be gotten in a short time, place the patient in as 
comfortable a position as possible, supporting the in- 
jured part upon a pillow, or a similar pad made of 
clothing or other suitable material. 

(b) Where a physician cannot be obtained, and 
where it may be necessary to move the patient any 
distance, further treatment may be attempted. Apply 
splints or some stiff material, properly cushioned, in 
such a way as to prevent the fragments of bone moving 
upon one another. 

(Y) If there is a prospect of several days elapsing 
before a physician's help can arrive, replace the frac- 
ture and dress it as specified hereafter in connection 
with individual fractures. 

2. Compound Fracture. This is a most danger- 
ous injury, and needs the most thoughtful care. It is 
to be treated like a simple fracture, and, in addition, 
the wound is to receive the treatment proper for such 
an injury. 

By far the most common variety of broken bone is the simple frac- 
ture, in which there is no opening through the skin and other soft parts 
down to the break. It readily heals when properly treated, and is not 
in the least a dangerous accident. 

If, however, it is carelessly handled, and one of the broken ends is 



174 EMERGENCIES AND ACCIDENTS 

pushed through the tissues to the external air, or an opening down to 
the break is made in any other way, it is transformed into a compound 
fracture, which, except under the most advanced surgical treatment, is 
an exceedingly dangerous injury, entailing prolonged illness, if not re- 
sulting in death. 

On the other hand, careless handling may not push the bone through 
the skin, but may cause it to cut across a large blood-vessel or an im- 
portant nerve, or in some way injure other tissues of importance, and 
in this way entail serious danger. Such an injury is called a complicated 
fracture. Since the bone may both push through the skin and produce 
these injuries, it is evident that a fracture may be both compound and 
complicated. It is hardly necessary to remark that the force causing 
the accident, and many other agents beside the bone, may render a 
fracture complicated. 

When a powerful force falls upon any portion of the body sufficiently 
strongly to crush a bone into several fragments, producing a commi- 
nuted fracture, the same force is very liable to injure the soft parts about 
it to such an extent as to render the fracture compound, and then we 
have a compound comminuted fracture. 

In some cases one end of the fractured bone is driven into the other, 
so that the fragments are wedged tightly together — this is an i?npacted 
fracture. The lack of an abnormal joint and of crackling in these cases 
makes their detection exceedingly difficult for the experienced surgeon, 
and entirely impossible for the amateur. 

A bone may be completely or partly broken. The former is a com- 
plete and the latter an incomplete fracture. The incomplete fracture is 
often called a green stick fracture, owing to its resemblance to a break 
in a green stick, where the tough, green fibres break with difficulty. 
This fracture is never found in the brittle bones of old people, but often 
occurs in young children, where, owing to the larger proportion of carti- 
lage or gristle, the bones are softer and tougher. 

If you strike your wrist violently with a hammer, you will break the 
bone at the point where you strike — this is fracture by direct violence. 
But if you fall from a distance upon the palms, you will break one of 
the bones between the hand and the shoulder; this is a fracture by 
indirect violence, the violence being applied at the shoulder and the 
hand, and the break being at a distance from both points. 

Cases sometimes occur where bones are broken by violent contrac- 
tions of the muscles. The knee cap is very subject to breaking by mus- 
cular action : its fracture, in the great majority of instances, being due to 
the violent contraction of the great extensor muscular mass of the thigh. 
I saw a soldier a short time ago who, while playing football, missed the 
ball with his foot in an attempt to kick it with great force : by this act 
his leg was thrown forward so violently as to break his thigh bone at its 
middle ; in other words, he kicked his leg in two by indirect violence. 



BROKEN BONES 1 75 

The more important signs of fracture are the fact of an accident 
having occurred, pain at a certain fixed point, the ability to bend the 
limb or move the bone in an improper location, and the crackling felt 
or heard at the point of the injury. 

All these symptoms may not be present in every case, for abnormal 
motion is absent in an impacted fracture, and it may be impossible to 
get crackling or crepitus, since other tissues may have gotten between 
the broken ends so as to prevent their rubbing together. And it is 
evident that there can be no crepitus in a green stick fracture, since the 
broken ends are not free to be rubbed together. 

When a bone is broken, the blood-vessels of the bone itself" and some 
of the surrounding soft tissues are broken, and a certain amount of 
bleeding occurs, followed by the formation of a blood clot between and 
around the broken ends. It takes about a week after the accident for 
this clot to be absorbed and carried off. During the second week a 
repair material called callus is thrown out about the broken points. It 
forms, in the case of long bones, a perfect sheath containing the two 
broken ends, and holding them in place; where the broken bone is 
hollow, callus forms in the medullary canal, and forms an internal 
support, further uniting the bone. A certain amount of callus also 
lies between the broken ends of bone, and acts as a sort of cement in 
causing them to hold together. The callus develops into cartilage, and 
after four to eight weeks into bone. The cartilage ensheathing and 
lining the bone, after about a year, disappears, being absorbed into the 
system ; but that between the ends of the bone remains a permanent 
part of the bone, from which it is called permanent callus. 

The indication for treatment of broken bones is to bring the frag- 
ments into proper position a?id keep them there. Any inflammation or 
other condition due to the injury is to be treated according to the needs 
of the particular case. The great majority of fractures occur in the 
limbs, and the general remarks upon the treatment of broken bones are 
applied to them. Fractures of the bones of the head and trunk are con- 
sidered only where treated individually. 

The injured point, if located in a part of the body covered by the 
clothing, should be uncovered and examined, due attention being given 
to the avoidance of pain to the patient by unnecessary movements in re- 
moving the clothing, and to the preservation of the clothing itself by 
unnecessary mutilation. Any limb may be neatly and satisfactorily 
exposed by carefully ripping up one of the seams in the garment cover- 
ing it. Moreover, when the splint is to be applied, the flaps of clothing 
folded assist in the formation of padding for it. 

The bringing the fragments of a broken bone into place, or " setting 
the bone," is called by surgeons " reducing the fracture." Where a 
fracture is complete, the ends of the bone are often drawn by the 
action of the muscles so that the ends overlap. To reduce a fracture, 



I76 EMERGENCIES AND ACCIDENTS 

then, it is necessary to pull the fragments in opposite directions until 
the ends can be placed end to end ; this is accomplished in case of a 
fracture of the arm bone, for example, by having one person, with his 
hands in the armpit, pulling in one direction, while another, holding 
the forearm and wrist, pulls in the opposite direction. When the 
fragments are drawn out far enough, the ends should be worked into 
their position end to end. 

It should not be forgotten that where the services of a physician can 
be secured within a few hours, and it is not necessary to move the 
patient, no attempts should be made to set the bone ; but that mean- 
while the fractured part should be pillowed in as comfortable a position 
as possible, and the patient kept perfectly quiet. 

Splints. — The fragments having been brought into the 
proper relation, the next object to secure is their retention in 
that position until nature can complete the healing process. 
This is accomplished by fixing the broken limb to some stiff 
material which will not permit movements of the broken 
pieces. Such applications are called splints. 

Four qualities are desirable in a splint : (1) It is absolutely 
necessary that the splint be composed of material sufficiently 
stiff to maintain the parts in position in spite of considerable 
tendency to displacement. (2) In order to properly support a 
broken limb, the splint must extend for some distance above 
and below the injury. And as the action of the muscles is 
liable to displace the fragments (Fig. 27), it is well to have 
the splints extend beyond the joints on either side of the 
injury, so that by T making it impossible to bend the joints, 
movements of the muscles may be obviated. (3) It is de- 
sirable that the width of the splint should be as great and 
perhaps a trifle greater than the thickness of the injured 
limb. In temporary dressings, however, this is often im- 
possible, and narrow articles, such as scabbards, ramrods, and 
broom-handles may be utilized in emergencies. (4) The 
surface of the splint which is to come next to the patient 
should always be cushioned with some soft and more or 
less elastic material to obviate irritation from an unyielding 
surface . 

It is generally best to have two splints, one on either side 
of the limb, both held in place by the same bandage passed 
about them when in place. 



SPLINTS 177 

In a hospital or in a surgeon's office may be found prepared 
splints, shaped to the limbs to which they are to be applied, 
and materials especially intended for the ready manufacture 
into splints. Among the latter are binder's board, felt, thin 
strips of wood glued to cloth, coarse wire cloth, and telegraph 
wire. Plaster-of-paris and similar bandages are used in the 
formation of permanent splints. 

But in ordinary emergencies the resources of the hospital 
and the surgeon's office are not available, and such materials 
as are at hand must be adapted to the purpose. It is difficult 
to conceive of a place where something from which to extem- 
porize a splint cannot be found. 

It has been remarked that splints must be cushioned with 
some soft material on the side coming in contact with the 
injured limb, for an unyielding surface might induce inflam- 
mation sufficient to greatly increase the trouble. Materials 
suitable for this padding may be found wherever splints are 
required. 

1. In a Dwelling or its Vicinity. — Small splints may be cut out from 
cigar boxes, and from ordinary pasteboard boxes, although the latter 
are usually so thin that several thicknesses are required ; the binder's 
board, with which the covers of books are made, is excellent. Laths, 
shingles, and bits of wooden boxes of thin materials are good ; while 
flour or sugar barrel staves are unsurpassed. Broom or mop handles, 
fire tongs, pokers and shovels ; rulers from the desk ; and many other 
articles may be found for this purpose. 

The padding may be made from cotton, clean rags from the rag-bag, 
crumpled soft paper, crumpled soft muslin, linen, cheese cloth, or other 
fabrics. 

2. In a Shop or Factory. — Tools and their handles, strips of leather 
belting, etc. 

Padding may be made from cotton waste, fine shavings, tow, oakum, 
and many other materials. 

3. On a Public Street. — Splints may be extemporized from umbrellas 
and canes, parasols, folded fans, and policemen's batons. 

Padding may be made from bits of clothing, crumpled grass, cotton, 
and articles of that kind. 

4. In the Country. — Splints may be found in branches, or sheets of 
bark from trees, bundles of rushes, straw or stiff grass, cornstalks, sugar- 
cane, and the like. 

Padding here may be gotten from the leaves, hay, grass, soft bits of 
clothing crumpled, and other soft and elastic substances. 



I78 EMERGENCIES AND ACCIDENTS 

5. On the Battle-field. — Splints here are easily extemporized from 
weapons of various kinds, such as bayonets, knives, swords, and sabres 
and their scabbards, ramrods, rifles, picket pins, leather from saddles, 
and the like. 

Padding materials are found here in grass, hay, crumpled clothing, 
saddle cloths, blankets, tow from the limber-chest, etc. 

Splints may be held in place by triangular bandages in the 
broad or narrow cravat form, by roller bandages, which may 
be torn from sheets or shirts, and other articles of clothing. 
Pocket-handkerchiefs, napkins, towels, and scarfs make excel- 
lent substitutes ; while even garters, suspenders, tape, cord, 
and straps of various kinds may be utilized. In fixing a 
splint in place, care should be taken to avoid bending the 
limb so tightly as to interfere with the free circulation of the 
blood in the part, and the tips of the fingers or toes should 
always be left uncovered, so that they can easily be felt, to 
see if coldness or a purplish color indicates interference with 
the circulation. 

Great care is demanded in handling persons with broken 
bones, not only to inflict as little pain as possible upon the 
unfortunate victim, but to prevent further injury. The trans- 
formation of a simple into a complicated or compound frac- 
ture is an easy matter, but one fraught with evil consequences 
of the most dangerous description. Permanent disability — 
not to speak of death itself — has not infrequently resulted 
from the ignorant or officious treatment of broken bones. 
The lung has been injured by a sharp fragment of a broken 
rib, an artery has been sawn off by the rough end of a frac- 
tured bone, and other important organs have been and are 
liable to be affected in the same way. 

In raising a fractured limb, it should be supported by a hand gently 
slipped under it, both above and below the injury, in such a way that 
there will be no tension on the break itself, and so that there is no 
bending at that point. If this be done with care, the limb may be moved 
with practically no pain. And the patient mayb>e transferred to a litter 
or to a temporary resting-place, or splints may be applied without fur- 
ther displacement of the fragments. In applying splints, where possible 
the help of a second person should be utilized to support the limb 
while the dressings are being put in place. 



SLINGS FOR BROKEN BONES 



179 



Slings. — The slings made from the triangular and roller 

bandages should always be used when available. But some- 
times they are not 

at hand, and other 

devices must be 

employed. The 

sleeve may be util- 
ized as a sling ; 

when it can be 

drawn on over the 

arm. it may simply 

be pinned to the 

breast of the coat : 

where it has been 

necessary to slit 

the sleeve, it may 

be drawn around 

under the arm and 

pinned to the 

breast of the coat 

also as a sling 

(Fig. 119). The 

front flap of the 

skirt of a coat may be used as a sling by turning it up and 

pinning it to the coat, or by cutting a small slit in one corner 
and buttoning it on to one of the but- 
tons of the garment in front (Fig. 120). 
Two small handkerchiefs may be used 
for a sling. The first should be tied 
around the neck as loosely as possible, 
the knot being as near the opposite 
corners of the handkerchief as possi- 
ble : the second should then be tied 
about the first in the same manner, and 
the forearm slipped through it. 

Patients should not be alone. — A man who 
Fig. 120. — Coat flap turned has received even so slight an injury as a 
up and utilized as a sling. fracture of the collar bone should not be left 




Fig. 119. — A sfit sleeve utilized as a sling. 




l80 EMERGENCIES AND ACCIDENTS 






alone, and certainly should not be permitted to go either to the surgeon 
or home unassisted. If able to walk, he should be helped ; and if in 
great suffering or unable to walk, he should be carried on a litter or in 
other ways, as described in the chapter on carrying the disabled. The 
reaction from an accident is liable to be accompanied by dizziness and 
faintness, even to unconsciousness, so that if alone, a fall may aggravate 
the injuries already received. 

The treatment required by fractures in various parts of the body 
differs in many respects, according to their location. The individual 
fractures, then, should be considered independently. 

Fracture of the Skull. — Causes : Either the skull cap or 
the floor of the skull may be affected. The former are due 
to falls, where the head strikes the ground, and to blows upon 
the head. The latter — fractures of the base of the skull — 
are caused by falls, striking upon the feet or upon the lower 
end of the spine in a sitting posture, or they are sometimes 
due to blows upon the vault of the skull itself. In some in- 
stances comparatively slight violence will cause very severe 
injuries. I have seen cases where the skulls of boys have 
been frightfully caved in by a blow from a base-ball club, 
carelessly thrown behind him by the batter. 

Symptoms : In a fracture of the skull cap there will be a 
large bruise, or more frequently an open wound, at the point 
struck. The bone will be movable or, if impacted, it will be 
depressed below the level of the skull. Fractures of the 
skull cap are almost always compound fractures. 

In a fracture of the floor of the skull there would usually 
be bleeding from the mouth, nose, and ears. The discharge 
of a clear, serous fluid — the cerebro-spinal fluid — from the 
ear is positive evidence of a fracture of the floor. The blood 
may settle in red patches under the eye. 

And in both cases there may be insensibility, with symp- 
toms of stunning and of compression of the brain. 

Treatment : Summon a surgeon immediately. Then carry 
the patient gently into a shady place, — a darkened room if 
possible. Lay him on his back, with his head and shoulders 
slightly raised, and keep him absolutely quiet. If there be 
an open wound in the head, it should be temporarily dressed 
with a wet antiseptic compress, as prescribed for the treatment 



BROKEN NOSE AND BROKEN JAW l8l 

of wounds. Any tendency to heat or fever should be com- 
bated by cloths wet with cold water or bags of chopped ice 
to the head. 

Fracture of the Nose. — Causes : A blow, a fall, or some 
crushing force, such as a wagon wheel running over the nose. 
The bones of the nose are prodigiously strong, and the vio- 
lence must be very great to cause the accident. 

Symptoms : The bridge of the nose is flattened down, or 
perhaps pushed to one side. The bones may be movable. 
Crackling or crepitus may be felt. The parts about the 
break soon display the signs of a bruise. The nose bleeds 
freely. The cartilage of the nose is fixed very firmly, so that 
it is rarely broken loose, although such accidents may occur. 

Treatment : Treat bleeding by injecting hot water and 
plugging the nostril, as described in connection with nose- 
bleed. Treat the bruise by moist fomentations, or a wound 
as directed for such injuries. 

Fracture of the Lower Jaw. — Causes : The lower jaw may 
be broken by a kick from a horse or a man. by a blow with 
the fist, a club, or a bottle ; by a heavy fall, striking on the 
chin, or by any similar accident producing direct violence. 

Symptoms : The patient often feels the bone give way at 
the time of the accident ; finds that he has not the power of 
moving it. and tries to support it with his hand. The gums 
are torn and bleeding, and the line of the teeth irregular. 
The broken fragments can be felt both in 
the mouth and from without, and crackling 
or crepitus can be felt on moving them. 
This fracture is often compound, opening 
into the mouth. 

Treatment : ist method. With the 
hand, gentlv push the bones into place, Fig. 121. — Treatment of 
and applv a broad cravat under the chin fracture of the lower 

1 L ' jaw with two triangu- 

and over the head ; then apply a narrow lar handkerchiefs . 
cravat in front of the chin, tying the ends 
behind the neck, and passing them under the first cravat on 
either side. The cravats may be made from triangular band- 
ages or from ordinary pocket-handkerchiefs. 




l82 EMERGENCIES AND ACCIDENTS 

2d method. Make a four-tailed bandage (page 101) from 
a piece of muslin, of sufficient length to pass under the chin 
and over the head, or by cutting a pocket-handkerchief diago- 
nally, leaving uncut a space about two inches long in the 
middle, and apply this like a four-tailed bandage. 

Fracture of the Collar Bone. — Causes : A fall upon the 
outstretched arm or upon the elbow. A fall upon the shoul- 
der. A blow or a fall upon the bone itself. The most com- 
mon of fractures. 

Symptoms : The shoulder drops downward and inward. 
There is loss of power in the arm, and the patient generally 
leans his head toward the injured side, and supports the elbow 
with the hand of his sound side. On running the finger along 
the collar bone, an irregularity can be felt, due to the projec- 
tion of the outer fragment, the inner being pressed inward. 
Keeping one hand upon this point, and with the other raising 
the affected arm, abnormal motion is felt, and the irregularity 
is to a considerable extent removed ; crackling or crepitus 
may also be felt. 

Treatment : Remembering that the function of the collar 
bone is to hold the shoulder upward, backward, and outward, 
it is evident that the treatment needed 
to correct the deformity is to apply such 
apparatus as will accomplish the same 
end. (i) Make a good-sized pad, two 
or, better, three inches in thickness, 
and (2) thrust it high up into the arm- 
pit, (3) at the same time pushing the 
elbow as high up as possible, while 

Fig. 122.— Treatment of frac- , . ■ 1 1 «i 

ture of the collar bone. keeping the arm as close to the side 
as the pad will permit. (4) Where 
triangular bandages are available, put on a large arm sling, so 
as to hold the arm' high up in this attitude. (5) With a broad 
cravat, a scarf, a couple of handkerchiefs folded diagonally 
and tied end to end, or a roller bandage torn from some con- 
venient material, bind the arm to the side. The pad for the 
armpit can with advantage be made wedge-shaped, three 
inches thick at its upper end and tapering to nothing below. 




BROKEN SHOULDER BLADE AND BROKEN ARM 1 83 

Fracture of the Shoulder Blade. — Causes : The fall of 
some heavy body directly upon the bone, by some crushing 
accident, by the kick of a horse, by a fall upon the back, and 
similar instances of direct violence. This bone is very rarely 
broken. 

Symptoms : Inability to move the arm freely without pain. 
Great pain at the injured bone. Unusual irregularities in the 
bone. Movability of the fragments. Crackling or crepitus 
on moving them together! Swelling and other symptoms of 
a bruise at the point of injury. 

Treatment : Apply a large arm sling, if a triangular bandage 
is available, or otherwise a substitute for it. Then bandage 
the arm to the side with a broad cravat or other bandage, as 
in fracture of the collar bone — the treatment being practi- 
cally the same, with the omission of the pad in the armpit. 
The bruises on the back should be treated with cloths wet 
with cold water, and other applications, like bruises else- 
where, until the arrival of the medical man. 

Fracture of the Arm. — Causes : A fall upon the arm or 
elbow. Direct violence, such as a laden wagon rolling across 
the limb. It may in rare cases be caused by violent contrac- 
tion of the muscles. 

Symptoms : The arm is helpless, and 
there is more or less change in its shape, 
shortening — if the fragments override 
one another — and an unnatural bending 
at the broken point, even where there is 
little shortening. The arm can be bent 
at an unnatural point, and at the same 
point — the site of the break — crackling 
or crepitus can be obtained. Fracture 
lying near the upper end of the bone is 
often very difficult to recognize. 

Treatment : An attempt may be made Fig. 123. —Treatment of 
to set the bone, one person steadying the fracture of the arm. 
shoulder by grasping with both hands in 
the armpit, while another pulls strongly upon the arm from 
below, and a third gently pushes the bones together with his 




184 EMERGENCIES AND ACCIDENTS 

hands over the break. If the first attempt is unsuccessful, a 
second should not be made, but all future efforts should be 
left to a surgeon. Then (a) place a pad composed of a 
folded towel or handkerchief in the armpit, (d) Make two 
or more splints out of such materials as may be available — 
laths, book covers, picket pins, etc. ; (c) carefully pad them, 
and (d) apply them about the arm, taking care not to draw 
the bandages or handkerchiefs too tightly, and yet tightly 
enough to hold the parts in place. • The splints which are to 
be applied to the outer face of the arm may well extend to the 
top of the shoulder above and to the tip of the elbow below ; 
while those that are on the inner side of the arm should be 
shorter. The object of the pad in the armpit is to avoid com- 
pression of the axillary nerves and blood-vessels by the inner 
splint. The forearm should then be well supported by a 
sling ; but in this fracture, unlike that of the collar bone, 
care must be taken not to push the elbow up, as it would 
tend to displace the bone. The small arm sling about the 
wrist should be used alone. 

Fracture at the Elbow. — Causes : A fall, striking upon 
the elbow. A blow upon the elbow. 

Symptoms : The patient cannot bend his elbow. Pain is 
felt at the joint, accompanied, after a while, by swelling and 
heat. Crackling or crepitus may be felt on 
bending the joint. 

Treatment : Take two straight splints, 
l, extemporized from any available source, 

_,B£ an( j k mc j t } lem together in the form of a 

right ang]e. Thoroughly pad the splint 

F,S " ,2 Yiint n angUkr thlls formed - and ' a PPlving it to the inner 
face of the arm and forearm with the thumb 
up, bind it securely in place. Support it in a broad sling, if 
available ; in others, if not. 

Fracture of the Forearm. — Causes : A fall or a blow. 

Symptoms : One or both bones may be broken. (1) If 
both bones be broken, the usual symptoms — pain, an un- 
natural joint, and crackling or crepitus — will show the 
character of the injury very clearly. 



BROKEN FOREARM AND BROKEN WRIST 1 85 

(2) If only one bone be broken, the indications are not so 
evident. The finger should then be run along each bone to 
see if there is any unnatural motion or unusual projection ; 
if an inequality is discovered, it is easy to determine whether 
the bone is broken at the point or not, by turning the hand 
around, when crackling or crepitus will be felt if there is a 
fracture there. 

Treatment : Get or make two splints as long, if possible, as 
from the elbow to the tips of the fingers, and pad them well. 
Bending the elbow to a little more than a right angle, place 
the forearm with the thumb up. Then apply the two splints, 
one to the back and one to the face of the forearm, and secure 
them firmly with whatever means may be at hand. Support 
the forearm in the large arm sling, with the hand raised a 
little higher than the elbow. 

Fracture at the Wrist. — It should be noted that this is 
not a fracture of the wrist proper, but of the lower end of one 
of the bones of the forearm — the radius. It has been called 
Colles' fracture, Barton's fracture, 
Pilcher's fracture, etc., from sur- 
geons who have particularly in- 
vestigated it. This is, next to 
fracture of the collar bone, the 
most frequent in the body. 

Causes : The cause is invariably. Fig 125 - The deformity in 

. J fracture at the wrist. 

forcibly pressing the open hand 

backward, as in a fall, when the hands are outstretched to 

break the fall, or in attempting to push some heavy mass. 

Symptoms : Pain at the point of the break. A deformity 
at the back of the wrist (Fig. 125), called the silver-fork 
deformity, from its resemblance to the back of a silver fork. 
On turning the hand about, crackling or crepitus may be 
felt, and the fragment may be seen to be movable, although 
they are more often firmly fixed, and the deformity is the 
chief symptom. 

Treatment : If a surgeon can be gotten within a day, simply 
apply a small well-padded splint until his arrival. If some 
time must elapse, set the bones by forcibly bending the hand 




1 86 EMERGENCIES AND ACCIDENTS 

backward and at the same time pushing the lower fragment 
forward. A surgeon would bind a broad strip of adhesive 
plaster about the wrist, which would be sufficient in the vast 
majority of cases to retain the fragments in place. But in an 
emergency, a small well-padded splint "should be applied, ex- 
tending from the fingers well up the forearm on the palmar 
face. Apply whatever sling may be convenient. 

Fracture in the Hand. — Causes: Direct violence, in the 
form of a blow or a fall. The hand may be broken in games 
of various kinds and in fighting. 

Symptoms : When one of the bones of the metacarpus 
forming the hand is broken, pain will be felt at the point, 
the fragments of the bone will be found to be movable, crack- 
ling or crepitus will be felt, and the knuckle with which the 
bone terminates will usually be sunken. 

Treat ment : Cut out a small splint from a cigar box, a bit 
of pasteboard, or something of the kind, having it long enough 
to extend from the tip of the fingers a little way up the fore- 
arm. Pad the splint well and apply it to th* palm, taking 
care to have a thick wad of padding in the palm itself. Bind 
this splint in place, and put the arm in a sling with the hand 
rather higher than the elbow. 

Fracture of the Fingers. — Causes: A blow or a fall — 
direct violence. An injury to which ball-players are very 
subject. 

Symptoms : Pain, an irregularity at the broken point, pos- 
sible motion there, crackling or crepitus, and swelling. 

Treatment : The fracture in this case can easily be set. 
After this apply a small well-padded splint of cardboard, 
cigar box, or even a twig from a tree, extending from the tip 
of the finger up to the wrist ; bind it firmly in place, and sup- 
port it in a small sling. 

Fracture of the Spine. — Causes : They may be indirect, 
from a fall upon the head, feet, or buttocks ; or direct, either 
from the body falling across some projection or from some 
heavy article falling upon the body. These injuries are more 
frequent in railroad accidents and in mines and factories. 

Symptoms : Paralysis of all that portion of the body below 



BROKEN SPINE AND BROKEN RIBS 1 87 

the injury, clue to compression of the spinal cord by the 
broken bone. Deformity may be felt upon gently running 
the tips of the fingers along the spine. But no attempt 
should be made to obtain motion, or crackling or crepitus, 
on account of the danger of still further injuring the delicate 
structures within the spinal canal. 

Treatment : On account of the danger of .increasing the 
injury, the treatment should be confined to placing the patient 
in as comfortable a position as possible, using the utmost pre- 
caution in moving him, to prevent injury. Apply hot dry 
fomentations to the body if cold, and send for a surgeon. 

Fracture of the Ribs. — Causes : A blow or a fall upon 
the chest. Squeezing in a crowd has been known to break 
ribs, while in still other cases violent muscular action in 
coughing has produced a fracture. The fifth to the tenth 
ribs are the more frequently broken, while the eleventh or 
twelfth, the " floating ribs,' 1 are rarely injured. 

Symptoms : The patient complains of a stitch at some 
point in the side, and his breathing is catching and in short 
breaths. Passing the finger over the painful spot, crackling 
or crepitus can usually be obtained, either by making the 
patient cough or by pressing with the thumbs alternately on 
either side of the break. In case the lung is torn by the 
sharp points of broken bone, which is frequently the case, 
there will be spitting of bright frothy blood. In many cases 
the symptoms are very obscure, and it cannot be decided 
whether there is a fracture or simply a bad bruise. In this 
case, the injury should be treated like a fracture. 

Treatment : In ordinary fractures, it is considered that the 
bones must be kept absolutely quiet in order to heal properly. 
But in case of the ribs, this cannot be done without stopping 
the breathing, which will be impossible. However, the indi- 
cation is to limit the breathing as much as possible, and this 
may be done by the application about the chest of two broad 
cravats of the triangular bandage. A broad flannel roller 
bandage carried firmly about the chest several times so as to 
cover it, is better still ; while strips of adhesive plaster long 
enough to extend half-way around the body, and passed from 



1 88 EMERGENCIES AND ACCIDENTS 

the spine to the breast bone, one overlapping the other, are 
better yet. The patient should be moved as little and as 
gently as possible, his chest and head being well elevated to 
prevent interference with his breathing. 

Fracture of the Pelvis. — Causes : Great and direct vio- 
lence, such as is incurred by the wheels of a heavily laden 
wagon passing over the hips, being squeezed between two 
railway cars, or being crushed by the fall of an enormously 
heavy weight. 

Symptoms : There is a sense of falling apart, the patient 
cannot stand, and an attempt to rise produces great pain. 
Crackling or crepitus is sometimes felt. And a most im- 
portant symptom is the fact of a tremendous crushing force 
having been exerted on the pelvis. Serious injuries to the 
bowels and bladder are apt to complicate this injury. 

Treatment : Summon a surgeon instantly. Place the pa- 
tient in a lying-down position, and pass a bandage about his 
pelvis. Handle him with the greatest care, and place him 
where he can have as nearly absolute quiet as possible. 

Fracture of the Thigh. — Causes : Direct violence either 
through a fall of the patient or through a fall of a heavy weight 
upon his thigh. Indirect violence, through a jump from a 
height or a fall of heavy matter upon his body. 

Symptoms : Differing somewhat, according to the location, 
the toes and foot are turned outward. There is pain at a 
fixed point. There is loss of power in the limb, which at the 
same time is shortened by the immense muscles of the thigh 
strongly drawing the lower fragment up with the leg. This 
is well shown in Fig. 27, page 32. The limb bends at an 
unnatural point, and crackling or crepitus may be obtained. 

Treatment : This injury is one in which much depends 
upon the treatment. With proper care, it will progress to a 
perfect recovery ; and on the other hand, with improper man- 
agement, permanent lameness and even death itself may 
result. Much depends upon the gentleness and skill with 
which the limb is touched. In so large an injury it is easy, 
by injudicious or hasty movements, to convert a simple frac- 
ture into a complicated one, by allowing the sharp points of 




BROKEN THIGH I 89 

the broken bone to thrust themselves through the tissues, 
or to pierce a blood-vessel, — accidents which may make it 
necessary to remove the limb. In all manipulations, then, 
employ the utmost gentleness. 

First, summon a surgeon without delay. Then, place the 
patient in as comfortable a position as possible, preferably 
on his back, slightly inclined to the injured side, and with his 
head and shoulders some- 
what raised. Then look 
about for material from 
which to extemporize a 
splint. On the battle-field, 
a rifle may be used. A c . lnf . a , ,, , ,. . 

J Fig. 126. — Broom-handle used as a splint 

board from a board fence for broken thigh. 

will do well. Two billiard 

cues or a broom-handle will answer the indications excel- 
lently. These should be padded with clothing, blankets, 
leaves, grass, hay, or whatever may be available, and laid 
along the outer side of the injured limb. The limb should 
now be drawn out straight to its full length, and the splint 
bandaged to it by a bandage just above and below the break, 
with another about the waist and about the knee and the 
ankle. This done, additional support should be given the 
limb by bandaging it to the other limb. 

If a surgeon cannot be gotten within a day, more perma- 
nent treatment may be applied. Place the patient on a bed, 
with the foot raised five or six inches higher than the head. 
Then put a stocking and shoe on the foot of the affected 
limb, first having slit the shoe in the instep a quarter of 
an inch above the sole on either side, and passed a strap 
of leather or cloth through it. Fill a pail or bag with ten 
or twelve bags, six by three inches in size, filled with sand or 
earth ; having fastened the strap through the shoe to one 
end of a cord and the pail to the other, pass it over the foot 
of the bed in such a way that the pail will not touch the floor, 
but hang suspended and constantly drawing upon the foot. 
In this way the muscles drawing, the leg up will soon be tired, 
and the ends of the bone will gradually be drawn into place 



190 



EMERGENCIES AND ACCIDENTS 



and retained there. In a less primitive fashion this is the 
treatment now given a fracture of the thigh by modern 
surgeons. 

Fracture of the Knee-Cap. — Causes : A blow or fall upon 
the knee ; great and sudden muscular exertion, such as is 
caused by efforts to regain one's equi- 
librium on standing or slipping. 

Symptoms : Inability to move the 
limb or bend the knee. The limb is 
not shortened, and. upon feeling of 
the knee, one part of the bone will be 
felt pulled up by the thigh muscles, 
while another is left in place attached 
to the ligament, and there is a marked 
depression between them. 

Treatment : Keep the leg straight, guarding against bend- 
ing it, which would have a tendency to further separate the 
fragments. Place a splint of some kind — long enough if 
possible to run the entire length of the limb — on the lower 
extremity, bind it firmly at the ankle and the thigh, and 




Fig. 127. — Separation of the 
fragments of a broken 
knee-cap. 




Fig. 128. — Splint and figure-of-eight bandage for broken knee-eap. 



include it and the knee in a figure-of-eight bandage, which 
would tend to draw the fragments together. 

Fracture of the Leg. — Causes : Direct violence : heavy 
bodies falling on the leg, kicks from horses, and the like. 
Indirect violence : heavy falls, jumps, and turns of the leg. 



BROKEN LEG AND BROKEN FOOT 



I 9 I 




Fig. 129. — Bundles of straw or rushes 
as splints for broken leg. 



Symptoms : Pain at a fixed point, swelling and an alteration 
in the contour of the leg. On running the finger along the 
bone, a point of unnatural motion will be found, and at this 
point crackling or crepitus may be obtained. Where both 
bones are broken, the injury is 
easily detected, but where but 
one is affected, there is more 
difficulty, since the other bone 
forms a splint maintaining the 
limb in position. 

Treatment : Lay the patient 
comfortably upon his back, and 
having provided two splints from whatever material is avail- 
able, pad them well, and apply them to either side of the leg. 

The splints would 
preferably be a little 
longer than from 
the knee to the sole 
of the foot. On 
the battle-field, they 
could be extempo- 
rized from bayonets 
and other weapons ; 
on the street, from canes and umbrellas ; and in a house, 
from a host of materials. The padding may be made from 
clothing, bedding, hay, straw, 
and other materials used for 
the purpose. In civil life, 
a pillow can always be ob- 
tained, and if the leg is laid 
in it and splints applied on 
either side, we have a most 
satisfactory temporary dress- 
ing. Additional security will be contributed by tying the 
two limbs together. 

Fracture of the Foot. — Causes : Direct violence, such as 
is inflicted by a horse stepping on the foot, or by a wagon 
running over it. 




Fig. 130. — Splint extemporized from bayonets. 




Fig. 131. — Pillow for fracture of the leg. 



I92 EMERGENCIES AND ACCIDENTS 

Symptoms : Pain, swelling, and other symptoms of a 
bruise, an alteration in the shape of the foot, motion at an 
unnatural point, crackling or crepitus. These fractures are 
often compound. 

Treatment : Uncover the foot and place it in a good po- 
sition. Dress a wound, if it be present. Apply wet cloths 
to the bruised spot. Support the foot by an angular splint 
(Fig. 124), which may be improvised by a short and a long 
splint tied together, and applied with an abundance of pad- 
ding to the side of the foot and leg. A surgeon should be 
consulted. 



CHAPTER XXI 

FOREIGN BODIES 

Foreign Body in the Eye. — Char -act 'er : Cinders from a 
railway locomotive ; grains of sand and similar bodies 
blown about by the wind ; bits of metal and grains of 
gunpowder. 

Symptoms : Feeling the body in the eye. A copious 
flow of tears. Sometimes the body can be seen em- 
bedded in the cornea or conjunctiva. 

Treat7nent : Close the eye for a few moments and allow 
the tears to accumulate ; upon opening it, the body 
may be washed out by them. Never rub the eye. 

If the body lies under the lower lid, make the patient 
look up, and at the same time press down upon the 
lid ; the inner surface of the lid will be exposed, and 
the foreign body may be brushed off with the corner 
of a handkerchief. 

If the body lies under the upper lid, (1) grasp the 
lashes of the upper lid and pull it down over the 
lower, which should at the same time, with the other 
hand, be pushed up under the upper. Upon repeating 
this two or three times, the foreign body will often be 
brushed out on the lower lid. (2) If this fail, the 



FOREIGN BODY IN THE EYE AND EAR 1 93 

upper lid should be turned up : make the patient shut 
his eye and look down ; then with a pencil or some 
similar article press gently upon the lid at about its 
middle, and, grasping the lashes with the other hand, 
turn the lid up over on the pencil, when its inner sur- 
face will be seen, and the foreign body may readily be 
brushed off. 

If the body is firmly embedded in the surface of the 
eye, a careful attempt may be made to lift it out with 
the point of a needle. If not at once successful, this 
should not be persisted in, as the sight may be injured 
by injudicious efforts. 

After the removal of a foreign body from the eye, a sensation as if of 
its presence often remains. People not infrequently complain of a 
foreign body when it has already been removed by natural means. 
Sometimes the body has excited a little irritation, which feels like a 
foreign body. If this sensation remains over night, the eye needs 
attention, and a surgeon should be consulted ; for it should have passed 
away if no irritating body is present. 

After the removal of an irritating foreign body from the eye, some 
bland fluid should be poured into it. Milk, thin mucilage of gum 
arabic, sweet oil, or salad oil are excellent for this purpose. 

Foreign Body in the Ear. — Character : Usually insects 
in adults, although other articles may find their way 
thither. Children may insert various small articles, 
including grains of corn, beans, buttons, and the like. 
Symptoms : The foreign body, particularly if a living 
insect, may be felt by the patient. In most cases, 
however, it is not felt. It may be seen in the ear on 
examination. It may have been seen to be inserted. 
Treatment : In case of a living insect, (a) hold a bright 
light to the ear. The fascination which a light has 
for insects will often cause them to leave the ear to 
go to the light. If this fails, (b) syringe the ear with 
warm salt and water, or (c) pour in warm oil from a 
teaspoon, and the intruder will generally be driven out. 
If the body be vegetable, or any substance liable to 
swell, do not syringe the ear, for the fluid will cause it 



194 EMERGENCIES AND ACCIDENTS 

to swell, and soften and render it much more difficult 
to extract. In a case of this kind, where a bean, a 
grain of corn, etc., has gotten into the ear, the body 
may be jerked out by bending the head to the affected 
side and jumping repeatedly. 

If the body is not liable to swell, syringing with 
tepid water will often wash it out. 

If these methods fail, consult a medical man. The 
presence of a foreign body in the ear will do no imme- 
diate harm, and it is quite possible to wait several days, 
if a surgeon cannot be gotten before. 

It will be remembered that at the bottom of the external auditory 
meatus, about an inch from the opening, lies the tympanic membrane, 
a very delicate structure, which is essential to hearing. Very slight 
pressure is sufficient to break this delicate organ ; consequently the 
insertion of button-hooks, hairpins, etc., into the ear in order to extract 
foreign bodies should never be attempted. I have known the tympanic 
membrane to be perforated and one of the small bones of the ear to be 
pulled out in an ignorant attempt to extract a foreign body, which a 
surgeon could have removed without the slightest difficulty. The tech- 
nical knowledge of the surgeon is required here, and he will use instru- 
ments constructed for the express purpose of clearing the ear. 

Foreign Body in the Nose. — Character: Usually small 
articles introduced by children, either into their own 
nostrils or that of their playmates. 
Symptoms : The irritation of the presence of the body in 
the nostril. The obstruction to breathing. The sight 
of the body. The knowledge of its introduction. 
Treatment : Close the clear side of the nose by pressure 
with a finger, and make the patient blow the nose 
hard. This will usually dislodge the object. 

If this fails, induce sneezing either by tickling the 
nose with a feather or something of the kind, or by 
administering snuff. 

The nasal douche, where a syringe or a long rubber 
tube suitable for a siphon is available, may be used in 
case the body is not liable to swell, injecting luke- 
warm water into the clear nostril with the expectation 
that it will push the body out of the other. 



FOREIGN BODY IN THE NOSE AND THROAT I95 

If these fail, and the body can be seen clearly, an 
effort may be made to rlsh it out by passing a pic 
wire, bent into a little hook, back into the nostril close 
to the wall, and catching the body with it. A hairpin 
may be bent straight and the hook formed at one end. 
Do not continue these manoeuvres very long nor let 
them be rough in the slightest degree. 

All simple efforts having failed, send for a physician. 
There is no danger in leaving the foreign body in 
place for some days if it is impossible to consult a 
physician in less time. 

Foreign Body in the Throat. Choking. — Character: 
Masses of food, bones, false teeth, etc.. in adults. 
Coins, buttons, marbles, etc., in children. 
Symptoms : Sudden difficulty in breathing, a distressing 
cough, retching, the face assuming a purplish hue, the 
eyes starting from their sockets, clutching at the throat. 
unconsciousne- - 

It is often difficult to tell where the foreign body 
lies. When it is possible for the patient to swallow, 
it is safe to presume that the body lies in the larynx 
or windpipe. 

When the foreign body lies in the gullet, there is 
little or no cough, although swallowing is impossible. 

When the foreign body lies in the pharynx, there is 
both coughing and inability to swallow. 

:>nent : The common practice of slapping the back 
often helps the act of coughing to dislodge choking 
bodies in the pharynx or windpipe. 

When this does not succeed, the patient's mouth 
may be opened and two fingers passed back into the 
throat to grasp the object. If the effort to grasp the 
foreign body is not successful, the act will produce 
vomiting, which may expel it. 

A wire, such as a hairpin, may be bent into a loop 
and passed into the pharynx to catch the foreign body 
and draw it out. The utmost precautions must be 
taken neither to harm the throat nor to lose the loop. 



I96 EMERGENCIES AND ACCIDENTS 

In children, and even in adults, the expulsion of the 
body may be facilitated by lifting a patient up by the 
heels and slapping his back in this position. 

Summon a physician promptly, taking car-e to send 
him information as to the cha?'acter of the accident, so 
that he may bring with him the instruments needed 
for removing the obstruction. 

Where there is no serious interference with the breathing, any action 
should be relegated to the surgeon. For, as a matter of fact, there may 
really be nothing in the throat, the impression of some body already 
swallowed remaining there. This often occurs in swallowing pills, a 
sensation as if the pill were in the throat not unfrequently continuing for 
a considerable time after it has passed into the stomach. 

It may be impossible by any means to remove foreign bodies from 
the gullet or windpipe. A surgeon will, however, remove them from 
the latter, opening into it in the neck by a comparatively slight opera- 
tion. If they are caught in the gullet, particularly if it be well down in 
the chest, a most serious operation may be demanded, requiring cutting 
into the stomach and reaching it from below. 

When a foreign body, particularly one with sharp or rough edges, 
has been swallowed, do not give an emetic, for it will only increase any 
possible trouble. Make the patient eat freely of soft bread, potatoes, 
and similar starchy articles of diet, that they may surround the body 
with a mass of waste matter, cover its sharp edges and carry it safely 
through the bowels. Coins, nails, fragments of bone and the like may 
be carried through the bowels in this way with perfect safety. 



CHAPTER XXII 

FAINTING 

Unconsciousness in General. — Sudden loss of conscious- 
ness is an accident frequently productive of the greatest alarm 
among bystanders, and deservedly so, for it is often the pre- 
liminary to a fatal illness. A very large majority of such 
cases are not dangerous, however, and they generally possess 
sufficiently marked characteristics to make it possible to dis- 
tinguish them readily. 



UNCONSCIOUSNESS IN GENERAL 197 

The cause of the insensibility often throws light upon the 
character of the trouble. If the patient has suffered a fall, 
striking upon his head, a depressed fracture would be proof 
positive of compression of the brain* while a similar fall, with- 
out any fracture and striking either upon the head or feet 
would indicate stunning. Fright, fatigue, loss of blood, and 
similar weakening occurrences would tend to produce faint- 
ing. Drinking freely of intoxicating liquors would cause 
drunkenness, while an irresistible tendency to sleep, after 
partaking of any suspicious medicine, would look like opium 
or chloral poisoning. Convulsions would suggest epileptic 
fits, hysteria, or kidney disease. A sudden insensibility in a 
person of advanced age after unusual physical or mental 
exertion would indicate apoplexy. Great weakness and de- 
pression, with or without unconsciousness, and following an 
accident or a sudden mental emotion, would suggest shock, 
while sudden loss of sensibility following exposure to long- 
continued heat would cause one to suspect sunstroke. 

If, however, the cause of the injury be unknown and the 
patient be found in a state of unconsciousness, the diagnosis 
must rest upon other points. And in this case a systematic 
examination should be made, beginning with the head. Com- 
pression would be indicated by a depressed wound, while a 
simple bruise would look more like stunning. The eyes 
should be examined to see if they are sensitive to the touch, 
and if so, brain injuries could be eliminated ; contraction of 
the pupils is a sign of opium poisoning, while unequal con- 
traction of the two pupils is a characteristic of affections of 
the brain. 

A glance at the face might discover that it is drawn to one 
side, in which case one-sided paralysis would be indicated, 
and pressure upon the brain either through a depressed injury, 
or apoplexy would be suspected. A bloated and flushed face 
is a sign of a hard drinker. 

The odor of liquor or opium on the breath would be a sign 
of drunkenness or poisoning, while froth at the mouth and a 
bite of the tongue or lip would be present in cases of epileptic 
and other fits. The breathing is slowed in great weakness, 



198 EMERGENCIES AND ACCIDENTS 

as in shock, and snoring in brain trouble, although it may be 
present in intoxication and poisoning by anodynes. 

A very slow pulse is found in brain troubles ; a very rapid 
pulse in sunstroke and other affections characterized by high 
fever, while a quick, thready pulse exists in great weakness, 
such as is present in shock. 

Abnormal coldness of the skin is to be expected in 
freezing, while it is always found in intoxication and in col- 
lapse from cholera, etc. Great heat of the skin, on the 
contrary, is found in sunstroke and diseases accompanied 
by high fever. 

Convulsions are present in epileptic fits, certain kidney 
troubles, hysterics, and in the indigestion and teething of 
children. 

Other points of distinction may be learned by a careful 
study of the symptoms attending the individual affections. 

Fainting. — Definition : A loss of consciousness due to a 
diminution in the circulation of the blood in the brain 
from a temporary weakening or stopping of the heart's 
action. Swooning. Syncope. 
Symptoms : Sudden paleness of face and whiteness of 
lips. Cold sweat on the brow. Pulse greatly weak- 
ened. Breathing quickened. Muscular power weak- 
ened, causing patient to stagger and fall. 
Treatment : Do not attempt to support the patient either 
in a standing or sitting posture. Lay him flat on his 
back with his head lower, if anything, than his feet. 
Let him have plenty of fresh air. Loosen tight clothing, 
such as collars and belts. Sprinkle the face with cold 
water. Apply smelling-salts to the nose if available. 
A glass of wine, or a cup of coffee, when consciousness 
has begun to return, will assist to give the patient 
strength . 

Fainting is the variety of insensibility most frequently seen, and 
occurs in a number of conditions, in all of which, however, weakness 
of the heart's action is present. Hunger and indigestion, pain and 
fright, heat and fatigue, tight lacing, and bleeding may all cause it. 
The close warm atmosphere of crowds is especially apt to induce it in 



FAINTING AND SHOCK I99 

the weak, and the fainting of one or more persons is an almost constant 
feature of large assemblages. Mental emotions acting upon the heart 
often produce fainting; bad news, and even good news suddenly re- 
ceived, often throws delicate people into a swoon. 

Among soldiers, aside from bleeding, fatigue is the most frequent 
cause of fainting. It is a common occurrence on a long or forced 
march for men, especially recruits, to fall out of ranks and into a faint 
by the road. Where the man has suffered greatly from heat, the con- 
dition is apt to be much more serious, heat-exhaustion being added to 
fatigue-faintness and demanding special treatment. 

The loss of consciousness is usually of very brief duration, although 
it may in exaggerated cases extend over several hours. The growing 
strength of the pulse, flushing of the cheeks and lips, and warmth of 
the fingers, indicate approaching recovery, followed by opening of the 
eyes and speech. 

The main indication for treatment is to restore the blood to the 
brain. This will be assisted mechanically by laying the patient down 
with his feet higher than his head. If he be seated in a chair, or if he 
fall into one, nothing can be better than to tip him directly back in the 
chair; his feet will then be kept higher than his head without difficulty. 

If bleeding be the cause of the accident, it is hardly necessary to re- 
mark that checking the flow of blood is the first thing to be done. 
Warmth should then be applied to the extremities and warm drinks 
administered. 

When a person faints in an assembly where the seats are placed 
closely together, it maybe convenient in some cases to cause the patient 
to lean forward with his head between his knees for a few moments, 
when he may have regained consciousness sufficiently to walk out of 
the room. 

When the patient does not become conscious in a few minutes, a 
physician should be summoned without delay. Meanwhile, heat should 
be applied to the pit of the stomach, and diluted whiskey or brandy 
may be injected into the lower bowel — a tablespoonful of either, di- 
luted with five or six times its bulk of warm water or milk. And if the 
heart is very weak and the breathing seems likely to cease, artificial 
breathing, as described in connection with Smothering, should be 
tried. 

Shock. — Definition : A state of great nervous depression 
induced by severe injuries. Collapse. 
Symfitoms: Following an accident, a surgical operation, 
or a mental emotion such as grief or fright, the face 
becomes pale and pinched and assumes an anxious, 
frightened expression. 



200 EMERGENCIES AND ACCIDENTS 

The patient is weak and faint, depressed and chilly. 

The skin is cold and suffused with cold sweat, espe- 
cially abundant on the forehead. 

The pulse may be absent, and if present is weak, 
rapid, and irregular, while the breathing is sighing and 
irregular. 

The eyes are dull and sunken, the pupils dilated and 
generally turned upward, while the finger-nails are of a 
bluish hue. 

The condition is greatly like dying, and differs from 
fainting in the fact that the patient is not necessarily 
unconscious. 

These symptoms are lessened in light cases and 
exaggerated in severe ones. 
Treatment : Lay the patient at full length on his back, 
with his head low. 

Loosen all tight clothing, — collars, belts, etc. 

If there is bleeding or other causative conditions, 
control them. Dress wounds and bind up broken 
bones. 

Rub the limbs and body, where uninjured, with 
flannel or similar substances, to restore the circu- 
lation. 

Treat the coldness by hot, dry fomentations applied 
along his body and his extremities. A hot plate 
wrapped in a towel may be applied over his stomach, 
and bottles of hot water, hot flatirons, stones or bricks, 
may be applied to other parts. 

Hot and stimulating drinks should be given him, 
under proper limitations. Hot coffee is always good. 
If there is no bleeding, whiskey or brandy in hot water 
or milk may be given, a couple of teaspoonfuls at a 
time. If the patient is so depressed that he cannot 
swallow, whiskey or brandy may be injected into the 
lower bowel, a tablespoonful in five or six times its 
bulk of warm water or milk. These doses may be 
repeated three or four times an hour until the patient 
is better. 



SHOCK AND STUNNING 201 

In shock, as in fainting, the brain is deprived of its proper supply of 
blood — indeed, it is held that shock is simply another form of fainting, 
differing simply in being the result of mechanical injury. 

The severity of shock varies greatly according to the person. A 
woman usually suffers less from shock than a man, although the weak, 
nervous, and timid suffer more than the strong, calm, and bold. The 
temperament of the injured person is almost as important a factor in 
determining the amount of shock as the severity of the accident itself. 
A plucky, determined man will endure a comparatively severe accident 
with less nervous depression than a flabby nervous individual. 

The mind has considerable control over shock. Not a few instances 
are on record where men have endured severe surgical operations, and 
through their mental equipoise banished shock entirely. The instinct 
of self-preservation may also prevent or delay shock. Sir Charles Bell 
tells of a sergeant of the King's German Legion at Waterloo, who, after 
his arm had been torn off by a cannon-ball, close to his shoulder, with- 
out any dressing whatever, galloped fifteen miles to Brussels ; but 
immediately upon arriving at the hospital he succumbed to shock and 
remained unconscious for a long time. 

The shock may be so slight as to need no treatment, a natural and 
slight reaction setting in immediately. In the more severe cases the 
reaction is longer in coming and greater in amount. It appears with a 
quickening of the pulse and flushing of the cheeks, with brightening of 
the eyes and dryness and heat of the skin, — the characteristics of fever, 
— and should be treated during the time which it lasts in the same way 
as fever of any kind. In other cases, and these the more fortunate, the 
heart simply regains its normal strength, the body returns to its ordinary 
warmth, and the mind resumes its wonted vigor — the system simply 
returns to the natural condition. 

A patient may suffer so severely from shock that reaction will not 
follow at all, in which case the symptoms will become more pronounced 
and gradually terminate in death. On the other hand, the reaction 
may be so violent as to produce congestive troubles, particularly of the 
brain, such as to render survival doubtful. 



Stunning. — Definition : A condition of the mind, extend- 
ing from bewilderment to insensibility, clue to shaking 
of the brain by sudden violence. Concussion of the 
brain. 
Causes : Blows or falls upon the head. Falls upon the 
feet, or the lower end of the spine as in jumping — in 
all cases the violence being transmitted to the brain 
either through the skull or spine. 



202 EMERGENCIES AND ACCIDENTS 

Symptoms: (i) Slight stunning: — After a blow or a 
fall the patient is confused, bewildered, and giddy for 
a few moments, with the pulse possibly a little weak, 
the breathing slow, and the face pale. 

(2) Moderate stunning : — After a blow or a fall, 
the patient lies insensible and immovable. His skin 
feels cold, his pulse weak and irregular, his eyes closed, 
and on examination his pupils are found to be con- 
tracted. May be aroused, but is peevish and falls 
back again into unconsciousness. After a time he 
becomes uneasy and tosses about, which is prelimi- 
nary to recovery : if vomiting occurs, it is a sign of 
recovery. 

(3) Severe stunning: — In this case the brain 
substance is usually torn and the symptoms are in- 
tensified. The patient cannot be aroused at all, 
the pulse is very weak and irregular, the skin is cold 
and clammy, and the patient is in a condition of 
marked shock, with a liability to excessive reaction. 
Death often occurs, and recovery is very slow, and 
liable to be complicated with acute congestion of the 
brain. 

Treatment: .(1) Slight stunning: — Rest, lying down 
with perhaps a cloth, wet with cold water, to the brow 
is all that is needed for slight cases. 

(2) Moderate stunning : — Rest, lying down, the 
head somewhat raised, and perfect quiet maintained in 
order to enable the patient to sleep. Warmth should 
be applied to his extremities and body in hot water 
bottles, etc.. as in shock. The head, on the contrary, 
should be kept cool by cloths wet with cold water, 
bags of chopped ice, etc. Stimulating drinks should 
not be given . 

(3) Severe stunning : — In this case the treat- 
ment should be the same as that for moderate stun- 
ning, particular attention being given to keeping the 
head cool, on account of the liability to excessive 
reaction followed bv inflammation of the brain. 



STUNNING AND BRAIN COMPRESSION 203 

Stunning is liable to be complicated with other affections of the 
brain. The most common are compression and inflammation of the 
brain. The former may be due to the bursting of a blood-vessel by a 
tear in the brain substance, which is likely to occur in severe stunning. 
The rupture is also liable to induce subsequent inflammation. 

The extreme liability of the brain to excessive reaction after stunning 
absolutely prohibits the administration of alcoholic liquors which, them- 
selves producing congestion of the brain, would greatly increase the 
danger of subsequent inflammation. 

Compression of the Brain. — Definition: Pressure upon 
the brain substance, producing loss of brain power. 
Causes : The skull may be broken and a fragment of 
bone pushed in upon the brain, a tumor may grow in 
the brain itself, a blood-vessel may have been cut, and 
the blood, running between the skull and the brain, 
press upon it ; when this occurs, with or without an 
external wound, it produces apoplexy, which is con- 
sidered on the next page. 
Symptoms : Profound unconsciousness, even the eyes 
being insensible to the touch, while one or both pupils 
are dilated, but not uniformly. 

The breathing is deep and snoring, with a puffing 
of the lips and cheeks with each breath. 

The pulse is full, slow, and labored. 

There is paralysis, more or less complete. The face 
may be drawn to one side. 

The signs of a broken skull may be found in cases 
due to that accident. 
Treatment : But little can be done for these cases except 
by a surgeon, who should be summoned at once. 

The patient should be laid down with his head 
1 somewhat raised, and any clothing compressing the 
person should be loosened, such as the collar, sus- 
penders, and belt. 

Dress the wound with cold, moist dressings and 
apply cold to the head in the form of cloths wet with 
cold water, or ice bags. 

Keep the patient quiet and in the dark, if possible. 

Give no sfantdants of any kind I 



204 EMERGENCIES AND ACCIDENTS 

Compression of the brain is apt to be mistaken for stunning, but 
a comparison of the symptoms given for the two accidents will make it 
possible to distinguish clearly marked cases. Stunning, however, is 
present in almost every case of compression, so that it is not often that 
we have a distinct case of the latter to observe. A doubtful case should 
be treated like one of compression, the more dangerous accident. 
Compression of blood from a bursted blood-vessel is called apoplexy, 
and is of sufficient importance to entitle it to distinct consideration. 

Apoplexy. — Definition ; Compression of the brain due to 
escape of blood between the skull and brain from a 
bursted blood-vessel. Paralytic stroke. 
Causes : Sudden mental or physical excitement inducing 
distention and bursting of one of the vessels of the 
brain weakened usually by advancing age. The blood 
thus escaped forms a clot between the skull and the 
brain and presses upon the brain substance. 
Symptoms : The subject is usually a person advanced in 
years. 

The patient usually falls suddenly to the ground as 
if struck down. 

In many cases he becomes unconscious at once, and 
when this does not occur, insensibility follows in a few 
minutes, and he cannot be aroused. 

The face is flushed. 

The eyes are insensible to the touch and irregularly 
dilated. 

The breathing is slow, labored, snoring, and puffing, 
the cheeks being puffed cut during expiration and 
sucked in during inspiration. 

Convulsive movements may occur. 

There is paralysis of one side of the body, shown 
by lifting up the hands, when one will be found to be 
cold and lifeless, while the other is normal. 
Treatment : Send for a medical man instantly. 

Make the patient lie down with his head slightly 
raised, and keep him very quiet and undisturbed. 

Loosen suspenders, collars, belts, and any tight 
articles of clothing. 



PARALYTIC STROKE OR APOPLEXY 205 

Apply chopped ice or cloths wet with cold water 
to the head. 

Apply warmth to the body and extremities by means 
of hot-water bottles, etc. 

Give no stimulating drinks of any kind I 

The cause of the bursting of the blood-vessel producing apoplexy is 
usually the softening and degeneration of the vessel due to advancing 
age. It most frequently affects persons over fifty years old. Anything 
which causes a strain on the vessels by overfilling them — such as joy 
or grief, bodily exertion or mental effort, a stooping posture, or a glass 
of wine — may burst the bleeding vessel. Younger persons, and even 
children, are occasionally attacked. Both physical indolence and 
mental activity render a man liable to it. 

A form of apoplexy is caused by excessive congestion of the brain 
without bursting of a vessel. This variety is more likely to affect a 
younger class of patients. 

Apoplexy is always alarming and dangerous. Many subjects, par- 
ticularly the elderly, never arise from the first stroke. Younger and 
more robust persons may survive a number of recurrences. The third 
stroke is apt to prove fatal, although this is by no means invariable, for 
double that number have been endured in some cases. The immediate 
danger of the attack does not pass away in less than ten days, and a 
patient should be carefully watched for that length of time. 

The paralysis due to apoplexy affects only one side of the body, and 
that the side opposite to the side of the brain injured. This is due to 
the fact that the nerves arising from the brain on one side cross to the 
other side to be distributed, as has already been described in the chapter 
on the Brain and Nerves. 

The object sought in the treatment of apoplexy is the diminution and 
checking of the bleeding. Direct treatment of the bleeding point being 
impossible, general measures for quieting the heart's action and assist- 
ing the formation of a clot must be adopted. Anything which would 
be likely to increase bleeding should be strictly avoided, such as admin- 
istering wines or liquors, lifting the patient into an erect posture, moving 
the limbs, or rubbing the skin. 

Apoplexy has often been confounded with less serious troubles. 
" Drunk 01 Dying," has been a frequent newspaper head-line to articles 
reflecting upon the police who have imprisoned a man suffering from 
a paralytic stroke, under the impression that he was " dead drunk." 

Apoplexy may be distinguished from Drunkenness (i) by the fact that 
the heat of the body is raised in the former and lowered in the latter; 
(2) vomiting is common in drunkenness, and (3) the subject can be 
aroused to a greater or less extent by pinching, etc., while in apoplexy 



206 EMERGENCIES AND ACCIDENTS 

there is no odor of liquor on the breath — this circumstance cannot be 
positively relied upon, however, since the subject himself may have 
taken a drink just before the attack, or the odor may arise from liquor 
which an officious bystander may have spilled in the effort to make him 
drink. 

Apoplexy may be distinguished from Opium Poisoning (i) by the fact 
that the pupils of the eyes in the latter are contracted uniformly to fine 
points; (2) there is no paralysis, and (3) the patient may be aroused 
by shouting at him, while (4) there is a characteristic odor of opium 
upon his breath. 

Apoplexy may be distinguished from Fits or Epilepsy (1) by the 
absence, in the latter, of one-sided paralysis, (2) by the foaming at the 
mouth, (3) by the spasmodic movement, and (4) by the short duration 
of the attack. 

One form of sunstroke is actually congestive apoplexy, and should be 
treated like apoplexy. Other varieties of unconsciousness may be 
differentiated from apoplexy by a careful comparison of their symptoms 
with those of that affection. 

Cases are liable to occur of most all of these affections which are so 
much like apoplexy as to deceive experts. In such a case the treat- 
ment should be that suitable to the most serious affection — an apo- 
plectic stroke. 

Drunkenness. — Definition : A state of more or less com- 
plete unconsciousness, resulting from drinking alco- 
holic liquor. Intoxication. Inebriation. 
Symptoms : These vary from a simple state of exhilaration 
to a condition of profound stupor, when the patient is 
" dead drunk/ 1 The symptoms given refer to the latter 
stage. 

Complete unconsciousness, from which the patient 
can be partially aroused. 

Face flushed and bloated. 

Eyes reddened and bloodshot ; the pupils equally 
dilated and fixed : if the eyeball be touched, the patient 
will attempt to close the eye. 

The lips are iivid, and the breathing is slow and 
redolent with the odor of liquor. 

The temperature of the body is lowered two or three 
degrees. 
Treatment : Cold water dashed in the face often proves 
a most satisfactory awakener. 



DRUNKENNESS AND SUNSTROKE 207 

Cause vomiting by tickling the pharynx with a feather 
or something of the kind.; by administering a table- 
spoonful of salt or mustard in a cup of warm water. 
Aromatic spirits of ammonia is very efficient in sobering 
a drunken man — a teaspoonful in half a cup of water. 

A cup of hot coffee after vomiting will aid to settle 
the stomach and clear the mind. 

Lay the subject in a comfortable position, applying 
hot, dry fomentations, if there is marked coldness. 

While intoxication is particularly noteworthy, because of its liability 
to be confounded with apoplexy, — from which it is distinguished by the 
signs noted in connection with that affection, — it is a condition fraught 
with danger in itself. 

Every one knows the effect of long-continued and often-repeated 
inebriation. The weak stomach, the enfeebled hand, the muscular 
trembling, and the shambling gait of the habitual drunkard are all 
familiar. But it is not so well known that alcoholic liquors taken in 
large quantities will cause fatal shock, — death occurring sometimes at 
once and sometimes within a few hours. These cases should be treated 
on the principles laid down for the treatment of shock. 

The system of an inebriated person is particularly subject to the influ- 
ence of cold. Nothing is more dangerous than to permit a man in such 
a condition to be subject to the influences of inclement weather, by 
lying exposed to rain, snow, or severe cold. The practice of confining 
a profoundly intoxicated man in a chilly and damp cell is very objec- 
tionable, for the same reason, — a fatal pneumonia or congestion of the 
brain is very likely to follow. 

It is sometimes very difficult to distinguish between drunkenness and 
apoplexy, and where the shadow of a doubt exists apply the treatment 
for apoplexy. In such a case never cause the patient to vomit. The 
treatment for apoplexy is not ill-adapted to drunkenness, and certainly 
will not be harmful ; while that for the drunkard might prove fatal to 
the apoplectic. 

Sunstroke. — Definition : Unconsciousness, due to exposure 
to the heat, usually of the sun. Heatstroke. Heat- 
exha 11st ion . Insolation . 
Causes : Exposure to long-continued heat — usually of 
the sun, but often to artificial heat in factories, etc., — 
is the chief cause : but bad air, excessive clothing, 
fatigue, and in particular intemperate habits are im- 
portant accessories. 



208 EMI 

ymfitoms : (i) Preliminary. In mai the attack 

is preceded by giddim . and na 

the eyes becoming bloodshot, and the skin hot and 
dry. 

I'm < cdcd by these symptoms or not, tl 
falls unconscious, the skin becoi dingly dry 

and hot, the breathing is quick and noisy, the pupils 
;im contracted, and the heart is rapid and tumultuoos. 
Treatment: Place the patient on his back, with his head 
■ d. in the coolest immediately available spot. 
Tin- chief objed of all treatment is to reduce the 

heal of the patient. 
After removing his clothing, pour a stream of cold 
water over his body, holding th< four or five 

above him. First pour on the head, then on his 
i and abdomen, and last on I 
Repeal until the patient becomes conscious* 

id may be applied in other \va\ s I 
ice to the head and armpits should he used when 

available. The patient may he wrapped in (old 

sheets, or laid in a hath-tuh which IS then to he tilled 
with <old w.i' 

Continue the cold applications until the patient be- 
comes Conscious, <•• the he.it is greatl) diminished. 

K ( new it again at once it the symptoms arise 
again. 

Heat-stroke seems to !><• an accident most common in the heated 
latitudes, or to persons who have not 
- unti i< . i >am] i l \ have 

an important influence on the production of heat-stroke, tin 
ot such accidents I the amount 

oi moisture in the atmosphere. Fatigue is another important f.c 
the causation ot h< Soldiers upon a long march on a hot day 

are extremely subject t<> it. Heavy clothing should be avoided in hot 
weather, although, on account of their favoring tl tion ot 

sweat from the body, woollen garments arc preferable. Anj 

which weak. •• in | xrtnancnl'.v or temporarily Will favor the 

production of lical Stroke, and ronlmcincnt in illv ventilated roon, 

the use of intoxicating liquors are i onspu uous among th< 



[N9ENSIBI1 i rv I'KOM POISONING 209 

The heat may cause mere]}/ a form ot exhaustion, without Insensl 
i.iinv, the patient complaining <>i greal weakness and headache, while 
others .n<- Incoherent and stupid, These cases are to be treated with 
cold applications, and rest on tin- gtMirral linos laid down for severer 
cases, but less enei getically, 

Anothei variety, however, is more serious and demands entirely 
different treatment, In these cases the attack seems to direct itself upon 
the heart, The skin Is comparatively cool, the face Is very pale, and 
the breathing is sighing or gasping, while the pulse Is rapid and hardly 
perceptible, fhe attack comes on with great rapidity, and the subject 
Galls to the ground, gasps, and sometimes expires almosl Instantly, [n 
these cases the shock ot cold applications should be strictly avoided; 
warmth should be applied externally and stimulating drinks Internally, 
The treatment which would save life in one case would be fetal In the 
other. 

rhe treatment oi the ordinary cases, however, is very simple, and 
consists in efforts to reduce the temperature oi the ovei heated blood. 
it i he patient is in a close room, he should be laid near an open w indow , 
it he is in the open air, he should be placed in the shade where a breeze 
can reach him, All tight clothing should be loosened and as much as 
possible removed, n in a dwelling house, it will be very convenient to 
place him in ;i bath tub; out oi doors, he can be laid on the grass, or 
the best available substitute for it. 

lu drenching him, the water may be gathered in .1 hat or bucket, or 
anything else thai will hold water, A watering pot Is an excellent instru 
menl for applying the water, Aftei the heal has been reduced, the 
patient Bhould be watched with tin- utmost care, and any rise in tern 
perature should be promptly met by a renewal ol the treatment, 

\u attack may be fatal at once, or il may lasl from a few minutes to 
forty eighl hours. Recovery is apt to be followed by permanent effects 
upon the system; the mind may be permanently weakened, 01 the 
patient may become a confirmed epileptic. \ liability to frequent head 
aches and musculai spasms is 1 not Infrequent result. 

Insensibility from Poisoning. Ih-finition : Loss of con- 
sciousness from taking sleep producing drugs. 
Causes 1 Taking opium including laudanum, morphine, 
paregoric, and its othei preparations chloral and 
anodyne mixtures. 
Symptoms : l ' nconsciousness progressively increasing, 
The pupils oi the eyes are contracted to the size of .» 

pin's point in opium poisoning. 

The breathing grows progressively slower, 



210 EMERGENCIES AND ACCIDENTS 

The smell of opium or chloral on the breath. 

Traces of the poison, or the bottle from which it has 
been taken may often be found. 
Treatment : Arouse the patient by slapping, pinching, 
and similar irritating proceedings 

When aroused sufficiently to swallow, give the 
patient an emetic of mustard or alum, a tablespoonful 
to a glass of warm water. Continue the vomiting by 
repeated doses given again and again. 

Make the patient drink freely of strong coffee. 

Keep the patient awake by slapping him with wet 
towels, pinching him, talking to him, and even making 
him walk up and down until he no longer feels the 
intense desire for sleep. 

The subject of opium and chloral poisoning is again referred to in 
the chapter on Poisons. 

Insensibility from Freezing. — Definition : Loss of con- 
sciousness due to exposure to extreme cold. 
Symptoms x Paleness and coldness of the frozen parts. 
Sluggishness of the pulse, slowness of the breathing, 
etc. 
Treatment ; Rubbing with cold applications in a cool 
but gradually warmed room. Stimulants and hot 
drinks as soon as the patient is able to swallow. Rest 
in warm clothing. 

The subject of freezing in all its details has been fully discussed in 
the chapter on Bruises, Burns, and Freezing. 



FITS 211 



CHAPTER XXIII 
FITS 

Epileptic Fits. — Definition : Periodical convulsions, due 
to disease of the brain. Epileptic convulsions . Falling 
sickness. 
Symptoms : Patient often utters a peculiar cry just before 
falling. Immediately becomes absolutely unconscious. 
Falls in violent convulsions, jerking the arms, legs, and 
body. 

Foaming at the mouth, grinding of the teeth, and 
biting of the tongue or lips are common. 

Face becomes livid, the eyeballs roll, and the pupils 
are unaffected by light. 

Fit lasts from five to ten minutes. 

Fit generally followed by drowsiness or deep sleep, 
sometimes by headache and debility. 
Treatment : Nothing can be "done to stop a fit. 

Place the patient so that he cannot strike his head 
or limbs against anything likely to injure them. 

Loosen the clothing about the neck and body to 
make the breathing and circulation as free as possible. 

Tie a handkerchief between the teeth and about the 
back of the head to prevent the teeth closing upon the 
tongue. 

Give the patient an abundance of fresh air. 

Favor his tendency to rest after the fit has ceased. 

Epilepsy is a disease of the brain which manifests itself in fits or con- 
vulsions, recurring at more or less frequent intervals, sometimes as often 
as two or three times daily. The victims generally experience premoni- 
tory symptoms, such as headache, dizziness, terror, or a peculiar creep- 
ing sensation like that of a current of air or a stream of water, beginning 
in a hand or foot and extending toward the trunk. Warned by these 
sensations, the subjects often attempt to place themselves in a situation 
favorable to the attack. 



212 EMERGENCIES AND ACCIDENTS 

On account of the suddenness of the onset, however, it is often im- 
possible for the epileptic to remove himself from dangerous locations. 
He may tall across a railway track, or down a flight of stairs, into a fire, 
or under water. In such cases, injuries of various kinds are likely to 
complicate the fit, and demand the treatment suited to them. If in a 
situation where his movements are likely to bring him into danger, it 
goes without saying that he should be removed. 

Epilepsy is rarely cured. As life advances, the mind is likely to be 
affected to a greater or less degree. Nevertheless, a number of the 
great men of history have been subject to epilepsy. Caesar and Napo- 
leon, Petrarch and Byron, Mahomet and Paul, were victims of the dis- 
ease, and achieved greatness in spite of it. 

Hysterics. — Definition : Paroxysms, varying in extent from 
an uncontrollable fit of laughing or sobbing to convul- 
sions similar to epileptic fits. 
Symptoms : The subject is usually a weak girl or young 
woman. 

May simply be affected with uncontrollable laughing 
or crying. 

May fall suddenly to the ground, with clenched 
hands, grinding of teeth, and jerking of limbs, in imi- 
tation of epilepsy. 

Partial unconsciousness is assumed, not real, as is 
shown by muscular resistance on attempting to open 
the eyelids. 

The convulsions are never so directed as to hurt the 
patient, nor does she fall uncomfortably, nor bite her 
tongue, as in epilepsy. 

There is no one-sided paralysis, no snoring breathing, 
nor flapping of the cheeks, as in apoplexy. 
Treatment : No treatment is necessary. A patient will 
promptly recover, if left alone. 

It is essential that no sympathy be shown. 

A dash of cold water in the face, repeated if neces- 
sary, will complete recovery in most cases. 

Hysterics must not be confounded with hysteria, which is an actual 
disease of the nervous system, demanding medical skill of the highest 
order for its treatment, and manifesting itself in a multitude of various 
symptoms. 



HYSTERICS AND CHILDREN S FITS 21 3 

Convulsions from Kidney Disease. —Definition : Parox- 
ysms, due to blood poisoning, from the failure of the 
kidneys to cast off waste products. 
Sympto?ns : Dropsy, particularly of the feet and lower 
limbs, existing some time previously. 

Patient presents convulsions, varying from twitch- ■ 
ings of the face and fingers to general severe jerk- 
ings of all the muscles of the body, with complete 
unconsciousness. 

The breath and skin have a clammy odor. 

The paroxysms may be preceded and followed by 
delirium. 
Treatment : Summon a physician instantly, notifying him 
of the exact character of the trouble. 

Place the patient in a comfortable position. 

Apply cold, moist fomentations to the head' — wet 
cloths or ice bags. 

Apply a mustard plaster across the small of the back. 

A previous history of kidney disease will exist in almost all cases of 
this kind and will help to distinguish it. It is not uncommon in women 
during the months preceding childbirth, and in this case it is fraught 
with great danger. 

• These convulsions are usually directly due to an alteration of the 
kidney by disease in which the excreting power of the urinary tubules 
is diminished, and the poisonous waste products, not able to be thrown 
off, are retained in the blood. 

Children's Fits. — Definition : Paroxysms, due to irritation 
of the nervous system in children. Convulsions of 
children . 
Causes : Constipation, indigestion, worms, eruption of 
teeth, fright, and similar irritating things. Convul- 
sions are not as serious in children -as in adults. 
Symptoms : Before a fit. fretfulness, restlessness, and 
gritting of the teeth in sleep. 

In a fit, the child is absolutely unconscious. 
The muscles of the face twitch, the body stiffens at 
first and then passes into a series of jerking motions — 
the head and neck are drawn backward, and the limbs 
violently bent and straightened. 



214 EMERGENCIES AND ACCIDENTS 

The pulse is very rapid and weak, the breathing 
hurried and labored, and the skin is wet with perspira- 
tion, often cold and clammy. 

After a few minutes the child usually recovers in a 
quiet sleep, but the fits may be repeated with short 
intervals between them. 

The first fit may be fatal, or later ones ; or recovery 
may be prompt and permanent. 
Treatment : A bath of water as hot as it can be borne 
should be prepared, a teaspoonful of mustard dissolved 
in it, if available, and the child should be set into it for 
several minutes, repeating the operation if the fit recurs. 

Follow this with an injection of a little oil or a great 
deal of soapsuds to clear out the bowels, in case the 
cause of the trouble may lie there. 
• Then tickle the roof of the mouth with a feather, or 
use other means to produce vomiting, since the cause 
may lie in the stomach. 

Summon a physician without delay. 



CHAPTER XXIV 

SMOTHERING 

Smothering, suffocation, or asphyxia is a state of uncon- 
sciousness due to cutting off the supply of oxygen to the 
lungs. Smothering may be due to a number of causes. The 
most common is drowning, where the water prevents the access 
of air to the lungs. Hanging and strangling, where the pas- 
sage of air through .the windpipe is prevented by compres- 
sion of that tube, are well known. Anything which will close 
the air-passage will produce smothering ; such are bits of food 
and other articles diverted from their proper channels in the 
attempt to swallow ; a variety of croup, in which the windpipe 
is stuffed up by secretions, comes into this class. Pressure 
upon the chest sufficiently to prevent ils movement in 



RESTORING THE BREATHING IN SMOTHERING 21 5 

breathing is another cause. The methods of Othello and 
Richard III., causing smothering by pressing a pillow tightly 
down upon the face, are classical. Smothering is the cause 
of death in persons who have been buried under avalanches 
of snow or sand, grain falls, and the like. 

Another variety of smothering is that produced when the 
atmosphere is so filled with other gases that the proper 
amount of oxygen cannot find its way into the blood. 
Smothering by breathing air filled with illuminating gas is a 
common accident in cities where the victims from carelessness 
or ignorance have failed to turn off the gas in extinguishing a 
light. The gases formed by burning coal and decaying sew- 
age, and the smoke of burning buildings, produce insensibility 
from the same cause. 

The restoration of the function of breathing is the chief 
aim in treating cases of smothering — by this means carrying 
off the waste, poisonous products from the blood and giving 
new life to the system by an abundant supply of oxygen. 

Restoring the Breathing. — The act of breathing is restored 
by causing the chest walls to expand and contract in the same 
manner as in the normal acts of inspiration and expiration. 




*& 



Fig. 132. — Restoring the breathing by Sylvester's method — Inspiration. 

This is called artificial respiration and is performed in sev- 
eral ways. One of the most convenient and useful is Sylves- 
ters method, which is as follows : — 

Lay the smothered person on his back, with a pillow of 
folded clothing or other articles under his shoulders. 



2l6 



EMERGENCIES AND ACCIDENTS 



Take a position at the head of the patient, grasp his arms 
just below the elbow, and draw them slowly and steadily up 
over the head, holding them there long enough to deliberately 
count four. 

Then push the arms down upon the chest, bending the 
elbows as they come down, and press them strongly, but 
gently, against the chest long enough to again count four. 

Repeat these movements until the patient begins to breathe 
naturally, or until it is evident that life is beyond recall. 




Fig. 133. — Restoring the breathing by Sylvester's method — Expiration. 

The first sign of returning breathing is a change in the 
color of his face ; if white, it becomes red ; and if red, it 
changes to white. With this a faint fluttering breath may be 
seen passing the lips. 

Drawing the arms up over the head pulls upon certain 
muscles which expand the chest, creating a vacuum which 
the air rushes in to fill. Pushing the arms down upon the 
chest again compresses it and forces the air out of the lungs. 
Air is thus drawn into and forced out of the lungs in the 
same manner as breathing. The blood is gradually purified 
by the oxygen brought into contact with it, and the system is 
again inspired with life. 

Marshall Hall's method was long the most popular method of restor- 
ing the breathing, and is still described at length and illustrated, in many 
works, in connection with the resuscitation of the drowning. It consists 
in laying the body on one side and rolling it on to the chest so as 



DROWNING 217 

to compress its walls and produce expiration, and on to the back, to 
permit the chest walls to spring out to their normal position, producing 
inspiration. The method is clumsy in requiring several assistants, and 
incomplete in that the amount of contraction and expansion of the 
chest is slight. Either Sylvester's or Satterthwaite's methods are vastly 
preferable to it. 

Howard's method is better than Hall's. The patient is laid flat on 
his back with a roll of clothing under his shoulders thick enough to 
allow the head to be thrown well back, and his hands are tied together 
above his head. Then kneeling beside or astride of the patient, the 
operator places his hands upon the lower ribs, grasping the waist, and 
presses them in by throwing his weight upon his hands, at the same 
time pressing upward. Then' he lets go with a push that brings him 
back to the kneeling position, the pressure producing expiration, and its 
removal, inspiration. 

Drowning. — Definition : Suffocation through the stoppage 
of the air-passages by fluid . 
Causes : The stoppage of the air-passages by fluid. Any 
amount of fluid will cause the accident provided that 
it is sufficient to prevent the passage of air to the 
lungs. Men have been drowned in a basin of water 
and a tankard of beer, as well as in water fathoms 
deep — the immersion of the face being enough. 
Symptoms : The chief symptom is the fact of the patient 
having been immersed in water. 

Upon being taking out, the face is swollen and 
purple. 

The lips are livid and the eyes bloodshot. 

The mouth, windpipe, and lungs contain a frothy 
fluid, and there is considerable water in the stomach. 

The tongue may be swollen and bluish, and grasped 
by the teeth. 

The feet and hands also are often swollen and 
discolored. 

The body is cold. 
Treatment : 1 . Summon a physician as soon as possible 
without leaving the patient in danger. 

2. The treatment should be applied in the open air 
unless prevented by inclement weather. 



2l8 EMERGENCIES AND ACCIDENTS 

3. The clothing should be rapidly removed, cutting 
with knife or scissors for the sake of haste, and the 
body quickly wiped dry. 

4. (a) Wedge open the mouth and keep it open by 
tying a handkerchief or bandage through it like a gag. 
This will also help to keep the tongue in place. 
(fr) Get rid of the water that is in the body, by rolling 
the person over on to his face, with his head a little 
lower than the body, if possible, and (c) then, getting 
astride of the patient, gently raise his middle by the 
hands clasped under the abdomen ; in a few seconds 
the water will have run out sufficiently to permit the 
next step. 




Fig. 134. — Emptying the water from the lungs. 



5. Restoring the Breathing, (a) Turn him on to 
his back, placing him on level ground, and keeping the 
mouth wedged open as before, (b) Place the left 
forefinger on the tongue to keep it in place, and 
(<;) with the right hand press upon the abdomen, 



DROWNING 



219 



making the pressure toward the back and head of the 
patient. Press gently at first, but increase the pressure 
until as much air as possible has been forced out of 
the chest, (d) Then withdraw the hand so that the 
lungs may fill with air. (e) Repeat these movements, 
at first making them three or four times a minute, 
increasing to ten or fifteen, and persisting at that rate 
until breathing has been re-established, or it is evident 
that the patient is dead. This is Satterthwaite's 
method of restoring the breathing. 




Fig. 135. — Restoring the breathing by Satterthwaite's method. 

Where several persons are present to assist, Sylves- 
ter's method may be used in addition to this. The 
arms should be pressed upon the chest at the same 
time that the abdomen is pressed upon. When the 
hand is withdrawn from the abdomen, the arms should 
be brought up by the side of the head. 

6. Wrap him in warm, dry clothing, blankets and 
overcoats, or other articles of clothing which can he 
borrowed. Then rub the limbs and body briskly under 
the clothing to assist in restoring the circulation. 



220 EMERGENCIES AND ACCIDENTS 

7. A good healthy reaction of the system having 
been obtained, the patient may be carried to a com- 
fortable room and placed in a warm bed. Hot dry 
fomentations, such as hot-water bottles, hot bricks, and 
the like should be applied to the body. 

8. When the patient is able to swallow, warm fluids 
may be fed to him with a spoon. Stimulants to a 
moderate extent may also be given, and he should 
be encouraged to pass into a restful sleep. 

The symptoms of drowning described are developed by suffocation, 
which the patient has fought as long as life held out, and more or less 
water has found its way into the lungs. In a few cases, the patient 
faints at once — the heart-beat and breathing stopping immediately, and 
the windpipe being closed by the epiglottis so that the water cannot pass 
through. Here the face of the patient is pale and flabby, and there 
is no frothy matter in the mouth and no water in the lungs. The treat- 
ment of both varieties is the same, but the prospect of recovery in this 
case is much better than the other. 

The importance of emptying the water out of the lungs and stomach 
has always been recognized. It is accomplished with perfect ease by 
the method given here. The plans of rolling upon a barrel or hanging 
up by the heels occasionally practised are 'barbarous and liable to cause 
harm rather than do good. They should NEVER be employed! 

The diaphragm or midriff is the chief factor in the methods of restor- 
ing the breathing. Satterthwaite's method is directed especially toward 
utilizing its function in breathing. In pressing toward the patient's 
back and head, he presses the diaphragm directly upward and pushes 
the air out through the windpipe. When he withdraws his pressure, 
the diaphragm returns to its ordinary position, and the air is sucked 
into the lungs to fill the increased space. When Sylvester's method is 
added to it, we have the breathing act still further imitated by the addi- 
tion of the chest movements to those of the diaphragm. Artificial 
respiration, as performed by the combination of these methods, is the 
most perfect substitute for the natural breathing possible. 

When the person has not been long in the water, it is often possible 
to restore breathing by irritating the nostrils with snuff, smelling salts, 
or ammonia, or tickling the throat with a feather, and rubbing the body 
briskly. But these methods are not to be relied upon, and too much 
delay in resorting to artificial respiration will endanger the life of the 
patient. Where there are several persons present to assist, one of these 
may apply these procedures in addition. 

It is difficult to decide just how long a person can be under water 



RESCUING THE DROWNING 221 

without dying. In some cases, it has been impossible to resuscitate 
persons after but a few minutes' submersion, while in others life has not 
been extinct after hours have been passed in the water. Hope, then, 
should not be abandoned even if an hour or two has elapsed since the 
patient sunk. 

The time required for artificial respiration to restore the breathing is 
also very variable, some cases responding in a few moments, while with 
others it is a matter of hours. Efforts then should be employed with 
great persistence, and discontinued only after hours of faithful labor 
have demonstrated their uselessness. 

Rescuing the Drowning. — Swimming is an art that is 
easily acquired with a little self-confidence, and when once 
learned is never forgotten. The main point for one to re- 
member — who does not know how to swim, and who has 
accidentally fallen into the water, or who is learning to swim 
— is, that the human body will float if properly managed. 

Even a very small article, such as an oar or a small board, 
will make it easy to keep the head above water, if the chin 
be rested upon it. And this can be done without any 
assistance. 

It is possible, however, to float without any assistance. The secret 
of success is a willingness to sink on the back so that the face alone 
will be out of water. Throwing the arms out of the water or attempting 
to get the head and shoulders above the surface will cause the entire 
body to sink. But if a person lies back, with his hands above his head, 
and allows the water to arise nearly to his mouth and lips, he may float 
for an indefinite period. 

The conduct of a bystander, in case of a drowning person, should 
vary according to his acquaintance with the art of swimming. 

If none of the bystanders can swam, and the person has sunk within 
reaching distance, they should hold an oar, a fish-pole, or something 
of the kind to him, that he may grasp it as he arises, as almost invaria- 
bly occurs at least once and often several times. If there is nothing 
else at hand, a coat should be taken off, and, holding it by one sleeve, 
the other or the skirts should be thrown to the unfortunate. Esmarch 
was told by an old sea-captain that he had saved many lives in that way. 

When life-preservers are available, their use will occur to any one in 
the presence of a drowning person. But it should be remembered that 
anything that will float may be substituted for it, such as boards, boxes, 
logs, sticks of wood, etc. If one is not a good swimmer, he may throw 
a float of this kind to the drowning person, and then obtaining one 
himself, paddle by its aid to the one whom he is trying to save. 



222 



EMERGENCIES AND ACCIDENTS 




Fig. 136. —Grasping the drowning person. 



When one is a good swimmer, and the drowning person is 
at some distance, he should throw off as much clothing as 
possible and swim out to him, taking great care to avoid his 

clutch, for the death of a 
would-be rescuer has often 
resulted from being grasped 
at an inconvenient point, 
hampering him so that he 
could neither save himself 
or the one whom he hoped 
to rescue. 

I. Swim behind him and 
grasp him, preferably, by 
the hair — or if that be too 
short, by the collar — with 
the left hand, and with the 
right hand grasp his right shoulder; he can thus be kept 
harmless, with his face above water. Hold him at arm's 
length, and "tread 
water." 

2. Watching 
the right arm of 
the drowning per- 
son until a favor- 
able opportunity 
appears, seize it 
at the wrist, and 
draw it behind the head. Then prepare to swim to shore. 

3. Having the right arm held behind his head, take a few 

strokes so as to 
float on the back 
and draw the 
drowning man 
on to the chest, 
gaining his con- 
fidence if possi- 
ble, and swim 

Fig. 138. — Drawing the drowning person on to the chest. t O W a 1* Q t 11 e 




Fig. 137, — Controlling the right arm. 




SMOTHERING BY GASES 223 

shore, not attempting to keep the head of either high above 
the water. 

4. If the drowning person be unconscious, the work is 
made much easier, for he can then be drawn upon the chest 
without an effort either to avoid his clutch or to render him 
harmless. 




Fig. 139. — Swimming to shore. 

Breaking through the Ice. — A person who has become 
apparently drowned by breaking through the ice should be 
treated according to the methods prescribed for drowning in 
general. 

To rescue such a person, it is not wise to attempt to walk out to him, 
for the ice may give way, and involve the would-be rescuer also. But 
if a person's weight is spread out upon the ice by creeping on all-fours, 
or, better still, by working his way flat on his abdomen, he may go 
where the ice would not bear the weight of a person erect. Or he may 
push a long board, a plank, or a pole out to the unfortunate, who may 
pull himself out upon it. Whoever attempts the rescue of a person 
who has broken through the ice, should attach to himself a long rope 
of some kind, with the other end made fast to the shore, for his own 
protection in case the ice gives way. 

Smothering by Gases. — The gas which is particularly 
liable to affect life is carbonic acid. It is present in nearly 
every form of noxious vapor, whether in the so-called sewer- 
gas, the coal gas used for lighting houses, the choke-damp of 
the mines, the bad atmosphere of crowded rooms, vaults in 
which the fermentation of wine or beer is in process, or in 
the smoke of burning buildings. 

Symptoms : The symptoms of smothering by gases are 
those of smothering in general — a swollen and purple 
face, livid lips, and bloodshot and staring eyes. 



224 EMERGENCIES AND ACCIDENTS 

Treatment : In case a man is overcome by noxious gases, 
the main thing is to get him out into the open air. 
Rapidly loosen and, if possible, remove his clothing. 
Hold him in a half-sitting posture, with his head higher 
than his feet — just the opposite of the attitude advised 
for fainting. Rub the whole body briskly with flannel, 
or other fabric and restore the breathing by performing 
artificial respiration. From time to time dash mod- 
erate quantities of cold water over the body. 

Caves and underground passages are liable to contain a greater or 
less quantity of carbonic acid gas. It is of frequent occurrence in mines, 
where it is known as " choke-damp," and in cellars containing ferment- 
ing beer or wine ; it is found in sewers and drains intermingled with 
the sulphuretted hydrogen — which gives the offensive odor to rotten 
eggs — and still more noxious vapors. For this reason all unused 
underground places should be entered with caution. If a lighted 
candle burns all the way to the bottom, when let down into a pit, no 
dangerous amount of carbonic acid is present; still there may be other 
dangerous gases by which visitors may be overcome. 

The first person to enter a pit or drain should carry tied to his person 
the end of a rope by which he can occasionally signal his safety to those 
remaining outside. Upon his failure to reply to any signals he should 
promptly be drawn out into the fresh air by the rope. Upon the dis- 
covery of noxious air in an excavation, it should be purified by violently 
agitating the air, by firing guns into it, by lowering and raising open 
umbrellas, by pouring water or quick-lime into it. When lowering a 
lighted candle, or firing a gun into a pit, precautions should be taken 
against injury by the possible explosion of inflammable gases. 

If it be necessary to enter a poisoned shaft to rescue persons already 
insensible, the rescuer should have his nose and mouth covered with a 
cloth wet with vinegar, and, as previously stated, should be connected 
with the outer world by a signal rope. 

If a room be filled with poisonous gas from any source, it is easily 
and rapidly cleared by opening the doors and windows from the outside. 
The victim should then be promptly carried out of the room and treated 
for smothering. 

The gaseous products of fire are a frequent cause of death in burning 
buildings, and it is worth while to remember that in a room full of 
smoke from such a cause, the purer air is to be found near the floor. 
Hence it is often best to creep into a room in a burning house on 
the hands and knees. Moreover, the flames are an indication of 
oxygen, and air can be found to breathe wherever flames are seen. 



SMOTHERING BY STRANGLING OR HANGING 225 

They may burn one, but they indicate air to breathe. If these facts be 
known and remembered, many lives may be saved both of the occu- 
pants of burning buildings and of those who would save them. 

Smothering by Pressure on the Chest. — This accident 
occurs when men are caught under falling earth or heavy 
debris, the face remaining uncovered. Other injuries which 
are liable to complicate the trouble add materially to the 
danger. 

In this case, the victims should be dug out with as little 
delay as possible, and the suffocation should be treated by 
loosening the clothing, rubbing the body and dashing cold 
water upon it, and restoring the breathing by artificial res- 
piration. 

Smothering by Strangling or Hanging. — This injury is 
most frequently self-inflicted with suicidal intentions, although 
cases occasionally occur where men are caught by the straps 
of a harness or bridle and dragged about by the neck by 
a fractious horse, or are strangled in other accidental ways. 

The most important point in the treatment of hanging is to 
cut the persoji dowti, and that with the least possible delay. 
When a person is seen hanging, it is homicidal to run to tell 
others of it before cutting him down, for in the minutes so 
occupied the victim may have passed completely to his death. 
So far as possible, support him with one arm, while cutting 
the rope with the other, so that he may not injure himself by 
falling too heavily to the ground. Then loosen the noose 
and treat him as for smothering from other causes. Quickly 
loosen, and if possible remove the clothing, keeping him in a 
half lying-down position, with the head higher than the feet. 
Rub the body briskly with flannel, towels, etc. Restore the 
breathing by practising artificial respiration, and dash cold 
water upon the body occasionally. 

In all these cases a surgeon should be summoned imme- 
diately, the measures prescribed being resorted to while 
awaiting his arrival. 



226 EMERGENCIES AND ACCIDENTS 

CHAPTER XXV 
POISONS 

Poisons. — Definition : A poison is any substance which 
taken into the system in small quantities will produce 
death or serious disorder. 
Varieties : Poisons may be general, affecting the entire 
system, or local, affecting some particular part pri- 
marily,* and the whole system only secondarily. 
Symptoms : The symptoms of the various poisons differ 
according to the individual drug. But certain of them 
possess enough characteristics in common to enable 
them to be grouped and to render it easy to distinguish 
them. They are : — 

i . Locally irritating poisons in which the symptoms 
are due entirely to the location of the poison. 

2. General poisons, causing local irritation in which 
the poison affects the system at large in addition to 
producing local irritation. 

3. Sleep-producing or narcotic poisons. 

4. General poisons in which there is no local irri- 
tation. 

Treatment: In the first class never cause vomiting. 
Give dilute acids to neutralize alkalies, and dilute alka- 
lies to neutralize acids. Follow with soothing drinks 
of oil, raw eggs, and flour and water. Give opiates to 
quiet pain, and whiskey or brandy to relieve the 
weakness . 

In the second class, except in case of arsenic, no 
emetic should be given, but the effect of the poison 
should be counteracted by bland doses of oil, flour 
and water, white of egg, and the like, while stimulating 
drinks should be given to counteract depression. The 
treatment of arsenic is peculiar to itself and should be 
studied individually in the tables. 



POISONS 



227 



In the third class, sleep-producing poisons, give an 
emetic ; after producing repeated vomiting make the 
patient drink strong coffee and other stimulating drinks, 
and use every available means to keep him awake. 

In the fourth class, general poisons, always give an 
emetic, follow with stimulating drinks to relieve weak- 
ness ; give opiates to relieve pain, and put the patient 
to rest. 
The individual poisons may best be considered in the form 
of a table, where they can moreover more quickly be found in 
an emergency. 

1. Locally Irritating Poisons. 



Poison. 



Symptoms. 



Treatment. 



Acids: — 

Muriatic. 

Nitric (aqua fortis). 

Oxalic. 

Sulphuric (vitriol). 



Excessively severe burn- 
ing pain in the mouth, 
throat, and stomach. 
Difficult swallowing. 
Great depression. Ex- 
tremities cold and 
clammy. Convulsions. 
(Death.) 



No emetic. Alkali (bak- 
ing soda, saleratus, 
magnesia, chalk, lime, 
plaster) — 3 or 4 tea- 
spoonfuls in a glass of 
water. Drink soothing 
fluids, like oil. Stimu- 
lating drinks, if neces- 
sary. Opiates to re- 
lieve pain. 



Acid, Carbolic: 
Creosote. 



Vomiting of frothy mucus. 
Lining membrane of 
mouth white, hardened, 
and benumbed. Severe 
pain in belly. Cold, 
clammy skin ; insensi- 
bility. Snoring breath- 
ing. Odor of carbolic 
acid. 



No emetic. White of 
eggs. Milk, or flour 
and water. Rest. Opi- 
ates. 



Alkalies : — 

Ammonia (hartshorn). 

Lye. 

Pearlash. 

Potash, Caustic. 

Soda, Caustic. 



Painful burning in mouth, 
throat, and stomach. 
Difficult swallowing. 
Bloody vomiting and 
purging. Great depres- 
sion, etc., like acids. 



No enietic. Dilute acids 
(vinegar or lemon 
juice). Soothing fluids, 
like oil, melted fat, thick 
cream, etc. Stimulat- 
ing drinks. Opiates to 
relieve pain. 



Silver : — 
Nitrate (Lunar caustic) . | 



Same as above. 



No emetic. Copious 
draughts of salt and 
water. Soothing drinks. 
Opiates. 



228 EMERGENCIES AND ACCIDENTS 

2. Ceneral Poisons, causing Local Irritation. 



Poison. 


Symptoms. 


Treatment. 


Mercury:— 

Corrosive sublimate. 

Calomel. 

Vermilion. 


Burning pain in throat, 
stomach, and bowels. 
Metallic taste. Vomit- 
ing and purging — fre- 
quently bloody. In- 
crease of saliva. Sleep- 
iness. Convulsions. 
Stupor. 


No emetic. Raw eggs, 
milk, or flour and water. 
Castor oil. Stimulating 
drinks. 


Arsenic:— 

Fowler's solution. 
Green coloring matter. 
Paris green. 
Rough on Rats. 
Scheele's green. 


Burning pain in stomach 
and bowels. Tender- 
ness of belly on pres- 
sure. Retching. Vom- 
iting. Dryness of 
throat. Clammy sweat. 
Convulsions. 


Cause repeated vomit- 
ing. Give hydrated 
oxide of iron made by 
adding 8 parts of am- 
monia water to io parts 
ofsolutionoftersulphate 
of iron. Then castor 
oil. Rest, and stimu- 
lating drinks if needed. 


Copper:— 

Verdegris. 
Blue vitriol. 
Food cooked in copper 
vessels. 


Similar to those of arsenic. 
Coppery taste in mouth. 
Tongue dry. Colic. 
Bloody stools. 


No emetic. White of 
eggs, if obtainable, — if 
not, flour and water. 
Ice. Opiates to relieve 
pain and excitement. 


Iron:— 

Copperas. 
Green vitriol. 


Burning pain in throat, 
stomach, and bowels. 
Colic. Vomiting. Purg- 
ing. Cold skin. Weak 
pulse. 


No emetic. Baking-soda 
in water. Then raw 
eggs and milk. Opiates 
for pain. Stimulating 
drinks for depression. 



3. Sleep-producing or Narcotic Poisons. 



Poison. 


Symptoms. 


Treatment. 


Chloral: — 

A white, crystalline sub- 
stance, with an acrid 
taste. 


Profound sleep. Breath- 
ing slow and shallow. 
Pulse weak, rapid, and 
irregular. Remains of 
poison near by. 


Cause vomiting. Stimu- 
lating drinks. Heat. 
Motion. 


Opium: — 

Laudanum. 
Morphine. 
Paregoric. 

Sleeping mixtures in 
general. 


Giddiness. Heaviness of 
the head. Sleepiness. 
Stupor. Pupils of eyes 
contracted to fine point. 
Signs of the poison near 
by. 


Cause vomiting. Stimu- 
lating drinks — strong 
coffee. Keep up breath- 
ing. Warmth. Keep 
patient awake by whip- 
ping, if necessary. Mo- 
tion. 



POISONS 



229 



4. General Poisons. 



Poison. 



Symptoms. 






Treatment. 



Aconite:— 

Wolfsbane. 
Monkshood. 



Great depression. Ex- 
treme weakness. Cold 
sweat. Numbness of 
extremities. Weak and 
slow pulse. 



Cause vomiting. Stimu- 
lating drinks. 



Belladonna:— 

Atropia. 

Deadly nightshade. 



Eyes very bright, and pu- 
pils enlarged. Dryness 
of throat. Paralysis of 
excretory organs. De- 
lirium. Convulsions. 



Cause vomiting. Opi- 
ates to relieve nervous 
excitement. Rest. 



Lead:— 

Red lead. 
Sugar of lead. 
White lead. 



Metallic taste in mouth. 
Cramps. Paralysis. 

Vomiting. Increase of 
saliva. Giddiness. 
Convulsions. Stupor. 



Cause vomiting. Large 
doses of Epsom or Glau- 
ber's salts. Stimulating 
drinks. 



Phosphorus :- 

Matches. 



Pain in stomach and bow- 
els. Vomiting. Purg- 
ing. Signs of poison 
near by. 



Cause vomiting. Mag- 
nesia in water. Soap 
suds. Rest. Warmth. 



Prussic acid:— 

Cyanide of potash. 
Oil of bitter almonds. 
Laurel water. 



Death may occur instant- 
ly in ordinaiy doses. 
In very small doses, 
giddiness, blindness, 
convulsions, fainting. 
Death may occur from 
smelling the odor only. 



No emetic. Stimulating 
drinks (strong) without 
delay. 



Strychnine:— 

Nux vomica. 



Slight shuddering. Feel- ' 
ing of constriction of 
throat. Starting s. 
Paleness. Intermittent 
jerkings. Convulsions, j 
Ghastly grin. 



Cause vomiting once or 
. twice. Rest. Opiates. 
Chloral. Tannin. 



Vegetable poisons:— 

Berries (Bitter-sweet, 
Deadly nightshade, 
Mountain ash, Poke, 
Potato). Hellebore, 
Hemlock, Horse chest- 
nut, Indian tobacco, 
Jamestown weed, Wild 
lettuce, Wild parsley, 
Rhubarb leaves, Toad- 
stools, Tobacco plant. 



Nausea. Depression. In- 
toxication, Stupor, etc., 
varying somewhat with 
the poison. 



Cause vomiting. Stirrn. 
lating drinks. Rest. 



23O EMERGENCIES AND ACCIDENTS 

Emetics. — In the majority of cases of general poisoning, 
the first step to be taken is to cause the patient to disgorge 
as much of the poison as possible by vomiting. Articles 
producing these acts are called " emetics. " 

1. Vomiting can be induced frequently by thrusting the 
finger back in the mouth to the pharynx ; where another 
person's mouth is in question a feather, or some other soft 
object, may be used. 

2. Drinking large quantities of warm water will often cause 
the desired effect. A little salt added to the water will in- 
crease the effect. 

3. Chewing and swallowing tobacco in considerable quan- 
tities will cause the stomach to rebel. The tobacco itself in 
this case is poisonous, but by inducing vomiting it acts as its 
own antidote. 

4. Drinking mustard or salt and water, made by adding a 
tablespoonful of common salt, or powdered mustard, to a 
tumblerful of lukewarm water, makes an excellent emetic. 

Medical men will administer ipecac, apomorphine, sulphate 
of zinc, tartar emetic, and other drugs. But the readily 
available means of inducing vomiting here given should be 
employed while awaiting their arrival. 

Weakness and shock following poisoning and its treatment 
should be treated by stimulation and warmth as already pre- 
scribed for those conditions. 

Poison Ivy, Oak, Sumac. — Certain plants produce a 
painful rash when they merely touch the skin. In some 
cases the eruption has followed a near approach only' to the 
plant, without direct contact, the poisonous effect being prob- 
ably due to a noxious emanation from it. The more common 
of these plants belong to the rhus family, and are commonly 
known as the " poison ivy, 1 ' or " poison vine," the " poison 
oak," and the " poison sumac." 

The poison ivy or poison vine {Rhus radicans) is a climb- 
ing plant growing luxuriantly upon trees and rocks, and 
somewhat resembles the woodbine or Virginia creeper. But 
the poison ivy is three-leaved (Fig. 140), while the harm- 
less variety is five-leaved. The poison ivy has a hairy 







POISON PLANTS AND POISONED WOUNDS 23 1 

trunk and often has little white berries from the axils of the 
leaves. 

The "poison oak"" (R/uis toxicodendron) is an erect plant 
twelve to eighteen inches in height, with a leaf like that of 
the poison vine, consisting 
of three smaller leaflets (Fig. 

uo). 

The "poison sumac " {Rhus 
venenata) is very similar to 
the ordinary sumac, except 
that, like the poison ivy, it 
has small, slender clusters of 
white berries growing from 
the axils of the leaves. In 
all oth^r sumacs the berries Fig ' ,40 ' " Leaf of the poison ivy or 

poison vine. 

are red and in close bunches 

at the ends of the branches, and these are not only harm- 
less, but have an agreeable and wholesome acid taste. 

Symptoms : A painful rash, sometimes uniformly red, and 
at other times consisting of collections of small eleva- 
tions, surrounded by a greatly reddened surface. It is 
rather more frequent on the hands, face, and neck, but 
is often seen on and about the thighs. It may last 
from two or three days in mild cases to one or two 
weeks in the more severe. 
Treatment : A very strong solution of bicarbonate of 
soda {baking-soda) will frequently check the trouble 
in the beginning. Any soothing ointment such as 
vaseline or petrolatum is also useful, and in the ab- 
sence of these lathering the part with a soft shaving- 
brush will diminish the itching and burning. 
Poisoned Wounds. — Certain poisons may be introduced 
directly into the circulation through wounds. Wounds may 
become poisoned in three ways : (1) By the development and 
multiplication of germs which induce death and decay of the 
tissues in an otherwise healthy wound. This variety of 
poisoned wounds has been fully discussed in connection with 
the germ theory, and rules have been given for its prevention 



232 EMERGENCIES AND ACCIDENTS 

and treatment. (2) Wounds may become poisoned by the 
introduction of a poison after they have been inflicted. 
And (3) wounds may become poisoned by being inflicted 
with some poisoned instrument. 

1. Poisons in common with most medicinal substances are 
readily absorbed through wounds with which they may come 
in contact. This is occasionally seen when, through the 
injudicious use of poisonous antiseptic agents in the treat- 
ment of wounds, or for other reasons, enough carbolic acid, 
corrosive sublimate, or iodoform has been absorbed to pro- 
duce serious and even fatal poisoning. Wounds into which 
the poison has been introduced after the infliction of the 
injury should be treated, prior to the arrival of a surgeon, by 
removing the source of the poisoning and then employing the 
measures ordinarily applied to healthy wounds. Great care 
should be taken to avoid the introduction of poisons by the 
prompt application to wounds of clean dressings. 

2. W^ounds may be poisoned by being inflicted by some 
poisoned instrument, such as a poisoned arrow or dagger, or 
the teeth of an animal, the fangs of a reptile, or the sting of 
an insect. Poisoned weapons are rarely used at the present 
time even by savages. 

If shallow, these wounds should be treated like bites of 
rabid animals ; but if deep, such treatment would be of little 
avail, and ordinary wound treatment must suffice until the 
advice of a surgeon can be obtained. 

Dog Bites, and wounds inflicted by the teeth of other 
animals, are usually simple wounds, unless the animal be mad. 
In this case the saliva of the animal contains a poison which 
is carried into the wound by the teeth, to pass into the circu- 
lation and produce a similar disease in man. 

Treatment : Absolute safety to a person who has been 
bitten by a mad animal can only be secured by initne- 
diately and entirely cutting or burning the wound out 
of the body. While preparations are being made for 
doing this a bandage or handkerchief should be bound 
tightly about the limb — the Spanish windlass (page 151) 
is excellent for this purpose — above the wound, to 






BITES OF ANIMALS AND INSECTS 233 

prevent the poison being carried into the circulation. 
The wound should be sucked to extract as much as 
possible of the poison, it being remembered that there 
is no danger from the poison being taken into the 
mouth, although it should be expectorated, not swal- 
lowed. Then with a sharp knife cut the bite out 
completely, or burn it out with a red-hot iron, or by 
filling it with powder and firing it. The patient should 
then be quietly laid to rest and given alcoholic drinks 
in large quantities to counteract the effects of shock. 
Snake Bites. — This injury is most commonly due in this 
country to the rattlesnake, the copperhead, and the moccasin. 
Symptoms : Following a bite, swelling and discoloration 
of the wound ; headache, chills, and great weakness. 
If fatal, death may occur in from a few hours to several 
days. 
Treatment : The bites of poisonous snakes may be treated 
in the same way as those of mad dogs. Suck the 
wound, — after having put a tourniquet about the limb 
above the bite, — taking care to expectorate the poi- 
son. Then cut or burn the bite and administer 
whiskey or other alcoholic drinks to the patient in 
large quantities. 
Insect Stings. — Under this head are included the bite of 
the so-called tarantula, as well as the stings of the centipede 
and scorpion, the wasp, hornet, and bees. 

The bite of the tarantula is sometimes fatal, and in Eastern 
countries the same result is said to follow the sting of the 
scorpion. But in this country the scorpion, as well as the 
centipede, does not produce fatal results, although the latter 
may inflict a painful and annoying injury. The bite of the 
tarantula and the stings of the centipede and scorpion should 
be treated in the same way as snake bites. 

Insects in stinging usually leave their stings in the wound. 
It should first be extracted and the wound then treated with 
a solution of baking-soda. Clay made up into a paste with 
saliva is a favorite application which may be used in the 
absence of soda. The sting can usually be forced out by 



234 EMERGENCIES AND ACCIDENTS 

pressing upon the skin by its side, or if a watch-key, or some- 
thing with an open centre be pressed down upon it, the sting 
will be pressed out. 



CHAPTER XXVI 
DEATH 

Death is the permanent cessation of all the functions which 
taken together constitute life. 

i . The lungs cease drawing in and throwing out air — pass- 
ing oxygen into the blood and extracting carbonic acid. 

2. The heart ceases throwing the blood inta the system 
and into the lungs. 

3. The blood stops carrying its freight of oxygen into the 
tissues and its load of carbonic acid out of it. 

4. The muscles cease acting and moving the body. 

5. The nerves stop carrying telegraphic messages from the 
mind in the brain and spinal ganglia. 

6. The viscera cease their digestive and excretory action. 

7. Heat and motion depart. 

8. The eyes become glazed and half open. 

9. There is no feeling in the body. 

10. The teeth are clenched, and froth often forms about the 
mouth. 

1 1 . The inciting power of all these actions, the soul, de- 
parts, and — 

12. The process of decay sets in. 

When all these conditions have been fulfilled, death has 
occurred without a doubt, but in some cases the functions are 
carried on so imperceptibly as not to be readily perceived. 
Cases have occurred where, owing to a temporary diminution 
of these vital phenomena, death has been simulated so suc- 
cessfully that persons have been buried alive. This is, how- 



DEATH 235 

ever, by no means as frequent as is often supposed, as is 
shown by the experience of certain foreign cities where pro- 
visions have been made for keeping bodies unburied until 
advancing decomposition places death beyond a doubt, sur- 
rounding them meanwhile with every appliance available for 
assisting resuscitation. Not a case is on record, however, of 
revival from trance or any other supposed counterfeit of death 
during all these years. 

There are a number of more or less positive proofs of 
death : — 

1 . The breathing has stopped : there is no movement of 
the chest ; the sound of the air passing in and out is absent, 
and there is no watery vapor proceeding from the mouth. 

2. The heart has stopped: there is no pulse; the move- 
ments and sounds of the heart have ceased, and the veins do 
not become swollen upon making pressure between them and 
the heart. 

3. The blood in the veins becomes clotted. 

4. The red color in semi-transparent parts disappears. 

5. The warmth of the body is replaced by coldness. 

6. The muscles of the body relax at first and then become 
stiff usually in from five to six hours, remaining so for from 
sixteen to twenty-four hours. 

7. There are no signs of rusting on a bright steel needle 
after plunging it deeply into the tissues. 

8. Electricity has no effect upon the contraction of the 
muscles. 

9. Decomposition of the tissues sets in, as is shown by the 
odor and the greenish blue discoloration, usually appearing 
first on the abdomen. 

The fact of the breathing having stopped may be deter- 
mined in two ways : (a) If the movements of the chest have 
absolutely ceased, there will be no movement in a glass of 
water, or better, a cup of quicksilver set upon the chest. 
(&) The absence of watery vapor proceeding from the mouth 
may be shown by holding a looking-glass or a bit of brightly 
polished metal, such as a razor-blade, over the mouth ; if any 
breath proceeds from the lungs, it will be shown by the 



236 EMERGENCIES AND ACCIDENTS 

collection of some drops of moisture upon the reflecting 
surface. 

The cessation of the heart's action may be shown by tying 
a string rather tightly around a ringer : if the person is living, 
the end of the finger will become reddened by the collection 
of blood beyond the string, and the removal of the string will 
leave a white line about the finger at that point. 

When the body has become cold and, beyond all question, 
when decomposition has set in, death has occurred. 



CHAPTER XXVII 
THE EMERGENCIES OF THE BATTLE-FIELD 

In no place is the demand for prompt attention to emergen- 
cies greater than on the battle-field. And with the progress 
of civilization, efforts to meet this demand have grown more 
systematic, until at the present time aid to the injured on the 
battle-field is rendered by thoroughly organized corps con- 
sisting of four classes: (1) Medical officers, (2) company 
bearers, (3) the hospital corps, and (4) civilian assistants, 
including female nurses, the various organizations for first 
aid to the injured, etc. 

The medical officers comprise all those connected with an 
army, and include (1) the surgeons and assistant-surgeons 
attached to regiments, and (2) the medical officers of the 
general staff, who administer the field — and permanent hos- 
pitals, etc. 

Tlie co?)ipa)iy bearers are certain privates of the line, who. 
in addition to their military duties, are instructed in first aid 
to the injured and in the transport of the disabled. These 
men are not detached from their companies, and being 
present in the line of battle, naturally bear the main burden 
of the immediate aid to the wounded. They must therefore 
be well drilled in rapid extemporaneous wound treatment. 



SANITARY SOLDIERS 237 

In the United States Army four company bearers are ap- 
pointed in each company, this number being chosen in order 
to give to each unit of the military organization a complete 
litter squad. Each company is provided with a litter for the 
4 use of this squad. The bearers wear a brassard of red cloth 
on the left arm, above the elbow, as a designating mark. The 
company bearers are expected to be selected with a view to 
their suitability for future transfer to the hospital corps. 

The hospital corps is a distinct organization, consisting of 
men whose duties are limited entirely to sanitary work, and 
is consequently of much greater importance in the care of the 
sick and wounded. Its members are selected because of their 
conspicuous adaptability to the peculiar duties of the corps. 
They must be brave and active, strong and gentle, and pos- 
sessed of presence of mind and inventive faculty sufficient to 
meet the varying emergencies of succor to the injured. 

The uniform of the hospital corps is similar to that of 
other enlisted men, except that the trousers are of dark blue 
cloth, bearing an emerald-green stripe piped with white, down 
the outer seam of each leg. They wear a white brassard 
bearing a red cross on the left arm, above the elbow (Figs. 
147 and 148), and the cap or helmet ornament is a white 
metal Geneva cross. 

The non-commissioned officers are known as hospital stew- 
ards, and they wear a sergeant's chevron of emerald-green 
piped with white, and having an arc of one similar bar across 
the top, the whole enclosing a red cross, and are armed with 
a straight sword. 

Certain privates of the corps are also detailed as acting 
hospital stewards, and are then practically non-commissioned 
officers, having an increase of pay and wearing chevrons like 
those of the hospital steward, omitting the arc : they also 
wear a straight sword. 

In case of active hostilities, the hospital corps is present 
with the troops in the proportion of two per cent of the 
aggregate strength of the command — a proportion which 
experience has shown to best supply the needs of the removal 
and care of the injured. To every ten privates of the hospital 



2$8 EMERGENCIES AND ACCIDENTS 

corps there should be an acting hospital steward, and to 
every thirty privates there should be a hospital steward. 

The privates of the hospital corps are organized into a 
company for each brigade, with their hospital stewards and 
acting hospital stewards under the command of an officer of 
the ambulance service, or a medical officer detailed for that 
purpose, and habitually camp near the division hospital, or, 
if there be none, the brigade or field hospital. 

To them is committed the exclusive care of the sick and 
wounded after they are brought to the first dressing-stations, 
and except by special assignment of competent military 
authority no others are permitted to take or accompany sick 
men to the rear, either on the march or upon the field of 
battle. They perform all the duties connected with their 
corps at various points, under the direction of their officers, 
and after an action or upon the completion of any special 
duty, they rendezvous at the camp near the division hospital. 

The non-commissioned officers are mounted in the field, 
and all the men are mounted when serving with mounted 
commands. A mounted private of the hospital corps, carry- 
ing a medicine case and such instruments and dressings as 
may be considered necessary, accompanies every medical 
officer into the field. 

The equipment of the hospital corps in the field consists of 
a canteen of water, a hospital corps knife, and one or more 
first aid dressing-packets. In addition to this, every fourth 
hospital private carries a hospital knapsack or dressing-case 
containing the requisites for prompt aid to the injured, and 
first dressings. 1 

1 In connection with the National Guard and State Forces it is often imprac- 
ticable to organize a distinct hospital corps, and in this case the company bearers 
may be utilized in the formation of a corps, which may not only form the nucleus 
of a hospital corps in case of active hostilities, but also provide for the safety of 
the community a body of men well instructed in meeting ordinary medical emer- 
gencies. This should be formed by the detail of four men from each company, 
of whom a proper proportion should be non-commissioned officers. 

For a regiment often companies the sanitary corps should be formed (i) from 
the regimental staff" by the Surgeon, the Assistant-Surgeon, and the Hospital 
Steward, who will act in the capacity of first sergeant; (2) from the companies, 
by one sergeant, four corporals, and thirty-five privates. 



SANITARY ORGANIZATION IN BATTLE 239 

The work of the hospital corps in the field is attended with 
some immunity by the provisions of the Articles of the 
Geneva Convention which have been adopted by nearly all 
civilized nations. The articles provide for the neutrality of 
field and permanent hospitals, of all their attendants, and of 
members of the hospital corps. — not of company bearers. — 
and permit the staff of hospitals to continue their labors after 
the occupation of the country by an enemy, or to pass unmo- 
lested to their own commands. The sick are protected, those 
caring for them are rewarded by protection, and wounded 
prisoners, when cured, are returned to their own country on 
parole. A flag having a red cross on a white field insures 
the safety of hospitals, while a white brassard on the left arm, 
also bearing a red cross, protects the members of the sanitary 
corps. 

During an engagement, and until relieved by the hospital 
corps detachment, the company bearers render first aid to the 
injured on the line of battle, under the supervision of the 
medical officers on duty at that point. Here the medical 
officers and company bearers, with the detail of the hospital 
corps, when it shall have arrived at that point, take measures 
to prevent immediate danger from wounds, not. however, 
attempting any operations. Those cases which demand 
immediate operative action are to be designated by a colored 
badge which is attached to their clothing by the first medical 
otficer into whose hands they may come. These will receive 
the first attention at the dressing-station. 

Immediate danger having been temporarily forestalled by 
the attention given on the line of battle, the bearers — of the 
hospital corps, or of the company, if the former have not 
arrived, or both, if the demand is too great to be satisfied by 
the hospital corps alone — place the wounded upon litters, if 

For a regiment of twelve companies, the sanitary corps should be formed 
(1) from the regimental staff by the Surgeon, the Assistant-Surgeons, and the 
Hospital Steward, who will act in the capacity of first sergeant; (2) from the 
companies, by two sergeants, four corporals, and forty-two privates. 

Such an organization, when properly instructed in anatomy and physiology, 
in aid in medical and surgical emergencies, and in the carriage of the disabled, 
will form a very satisfactory peace substitute for a hospital corps. 



24O EMERGENCIES AND ACCIDENTS 

they are unable to walk, and carry them back to the next 
point. If the injured are able to walk alone or with the assist- 
ance of a single helper, they are not carried. 







Fig, 141. — The work of the first line. 

The next point of relief, as well as all the remaining points, 
is to be located by the medical director of the army corps, or 
the senior medical officer present. It is the first dressing- 
st at ion ^ and is situated as near the line of battle as possible, 
consistent with safety. When the troops are fighting behind 
fortified works, it may be on the line of battle itself. In any 
case no attempt is made to place it beyond the range of 
artillery fire, but it should be so placed as not to be affected 
by ordinary rifle fire, and in as sheltered a spot as possible. 
To this point are brought or sent all wounded men. Here 
are performed all urgent operations, and here the wounded 
are prepared for conveyance to the field hospitals. 

The importance of this station is recognized by the sur- 
geons of the present day, among whom the character of the 
first dressing is considered to be of paramount importance. 
Whence the necessity of surgical assistance at this point, 
ample both in amount and in skill, will be evident. 

The first dressing-station is established earlv during; the 



FIRST AID ON THE BATTLE-FIELD 24I 

engagement by men of the hospital corps under the direction 
of the medical officers, care being taken not to locate it at a 
point where it will be in the way of the manoeuvres of the 
combatants. This having been done, the men provide water 
and straw, prepare the dressings, and when required assist in 
the removal of the wounded. This is the point beyond which 
the company bearers cannot pass. After depositing their 
charges they are required to return to the front. When the 
line of battle is of considerable length and large bodies of 
troops are engaged, there are a number of these stations, 
varying according to the necessities of the case, certainly not 
less than one to each brigade. 

The wounded having received proper immediate treatment, 
they are now to be transported to the field, hospitals. At a 
point as near the first dressing-station as possible the ambu- 
lances rendezvous for this purpose. This point is the ambu- 
lance station, and the injured are borne to this point upon 
hand-litters. Where the character of the country is such as 
to permit it, the ambulances may be driven directly to the 
first dressing-station, thus obviating the necessity of having a 
separate station. In removing a man, care is taken to send 
with him his arms and accoutrements, always seeing that his 
piece is discharged before placing it in the ambulance. At 
the ambulance station tents are pitched and arrangements 
made for the temporary accommodation of the wounded as 
they are brought in from the first dressing-stations. Attend- 
ants are at hand with hot drinks and other means of relieving 
suffering. Medical officers are present to inspect the patients 
and make it sure that they are in a suitable condition to be 
forwarded ; dressings are altered if necessary, and other at- 
tentions, the need of which may have been overlooked at the 
first dressing-station, are given. 

The three points now enumerated all lie near the line of 
battle, and are all included in the phrase the first line of 
medical assistance. The combination is also known as the 
service of the front. 

An important part of the duty of the hospital corps stationed 
at the front is the careful examination of the field after an 



CARE OF WOUNDED IN BATTLE 243 

engagement, to see if any wounded men remain uncared for, or 
to ascertain if any men supposed to be dead still show signs 
of life. If there is simply a cessation of hostilities due to the 
nightfall, the search is greatly facilitated by the use of the 
electric search-light (Fig. 142), and where one is not present, 
lanterns must be used. 

The fourth point is the field hospital or division hospital, 
still further to the rear. The field hospitals form the second 
line of medical assistance. They are located by the medical 
director at points decided upon in consultation with the com- 
manding general. A field hospital should be two or three 
miles to the rear of the dressing-stations, and should be more 
permanently organized. The duties of the hospital corps 
here are multifarious, and consist in arranging the beds for 
the wounded, assisting the surgeons in operating and in 
applying dressings, administering stimulants to this man, and 
sedatives to that one, caring for the belongings of the patients, 
and maintaining order in the hospital — meeting all the innu- 
merable emergencies which necessarily arise at such a time. 
The hospital steward in charge of the stores will have estab- 
lished his kitchen at a suitable point, and his cooks will be 
engaged in preparing not only the necessaries for the sick, 
but the food for the attendants. The hospital steward in 
charge of the medicine wagon will have abundant occupation 
in putting up such medicines as may be demanded, while those 
to whom is assigned the care of instruments and dressings 
will have no time to spare. A guard is mounted and the 
hospital property patrolled to prevent injury to its occupants 
or loss of property. 

The field hospitals are necessarily temporary in character, 
and the sick and wounded require more permanent quarters 
for their ultimate treatment. These are found in the third 
line of medical assistance, which consists of the stationary 
hospitals in the extreme rear, and includes the general hospi- 
tals located in the vicinity of the base of operations, and still 
farther to the rear, and includes hospital boats and hospital 
railway trains. The nursing and attendance at these points, 
as at others, falls upon the hospital corps with the assistance 
of volunteer male and female nurses. 



244 EMERGENCIES AND ACCIDENTS 

In this way is provided a complete system of treatment for 
the sick and wounded, covering the entire period from their 
fall upon the battle-field to their recovery and discharge from 
the general hospital. 



CHAPTER XXVIII 
CARRYING THE DISABLED 

In carrying the disabled for short distances, a manufactured 
litter is to be used where practicable, consisting essentially of 
a bed long enough and wide enough to hold a man lying 
upon his back, and having along either side a pole projecting 
at each end for handles. 

The authorized litter of the United States Army consists of two poles 
of seasoned white ash, seven feet eight inches long and an inch and a 
half square, the ends rounded off for handles. The poles are connected 
two feet from each end by wrought iron braces twenty-three inches in 
length and three-quarters of an inch in diameter, hinged in the middle 
by a clamp joint. The legs consist of wrought iron straps an inch and 
a half wide, bent into a suitable shape with rounded corners, each leg 
fixed eighteen inches from the ends of the handles. A canvas bed, six 
feet long, is tacked on the poles at equal distances from the ends, so as 
to be tightly stretched when the cross-braces are extended. This litter 
is used both as an ambulance litter and as a hand litter. In the latter 
case, its carriage is assisted by two slings of strong webbing with a loop 
at one end, and at the other a strap and buckle, by which its length can 
be adjusted : the sling is a part of the equipment of the bearer, and not 
of the litter. The question as to whether the litter shall have sliding 
handles or not has not yet been fully decided. The Halstead litter — 
an excellent form similar to the above, but with folding legs — -"is, how- 
ever, still used at all army posts, and is shown in most of our illustra- 
tions. The Otis litter is similar in plan to the Halstead, but has sliding 
handles and shorter folding legs, being designed for use in the Otis 
ambulance, the ambulance still in use in the army. 

To the injured man the slightest movement may be preg- 
nant with excruciating agony. The least jar is productive of 
actual torture. A mere touch may cause him to shriek with 
pain. The chief aim ? then, in carrying him is to move with 



CARRYING THE DISABLED 245 

such gentleness and care as to render the motion as nearly 
imperceptible as possible and certainly free from any jar. In 
order to accomplish this, there must be a perfect understand- 
ing among the several bearers, as to the course to be taken 
and the method to be adopted, and all must unite in perform- 
ing the movements in perfect unison. A well-defined uniform 
system of manipulating the injured, which may be perfectly 
understood by all participating in the movements, is then a 
prime requisite for success. The system of the United 
States Army 1 is the result of a long series of experiments 
and careful comparison of the work of others during several 
years of study by the entire medical and hospital corps, and 
is the best yet devised. We have been kindly permitted to 
reprint this system, with the addition only of explanatory 
illustrations, and designating by the smaller type those por- 
tions not necessary for the civilian bearer. 

THE DETACHMENT. 

1 . The detachment is formed in single rank, privates of the 
Hospital Corps on the right, company bearers on the left, 
each class graduated in size, the tallest men on the right. 

2. The senior hospital steward is on the right of the line ; 
the junior and acting hospital stewards are in the line of file- 
closers in order of seniority from right to left. The file-closers 
are posted two yards in rear of the line, and are equally dis- 
tributed along it. If the detachment is large, the second 
steward may be placed on the left of the line as guide. 

TO FORM THE DETACHMENT. 

3. The steward, facing the detachment and six yards in 
front of its centre, commands : 

Fall in; 

at which the men form in single rank, facing to the right. 

1 The Manual of Drill for the Use of -the Hospital Corps, U. S. Army. 
Published by authority of the Secretary of War. Washington, Government 
Printing Office, 1891. 



246 EMERGENCIES AND ACCIDENTS 

4. The steward having sized the men, and having seen that 
the file-closers are in their proper positions, commands : 

Left, Face ; 
and calls the roll. 
He then commands : 

Count, Fours.; 

and, facing to the front, salutes the officer in charge, who is 
in position at a suitable distance in front of the centre of the 
line, reports the result of the roll-call, and then takes his 
place on the right of the detachment. 

5. The steward having saluted, the junior officers take 
posts, assistant surgeons in the line of file-closers, and sur- 
geons four paces in rear ; they distribute themselves equally 
along the line, in order of seniority from right to left. 

The officer then commands : 

Right, Dress; Front. 

TO MOVE THE DETACHMENT. 

6. The detachment having been thus formed may be moved in line 
or in column of files, of twos or of feurs, as follows : 

In Line. 

To march forward, by the commands : (1) Forward, (2) Guide right 
(or left), (3) March. 

To march backward from a halt: (1) Backward, (2) Guide right (or 
left), (3) March. 

To side step at a halt : (1) Side step to the right (or left), (2) MARCH, 
(3) Detachment, (4) HALT. 

To pass from quick to double time: (1) Double time, (2) MARCH; 
to resume the quick time: (1) Quick time, (2) MARCH. 

To change direction during a forward march: (1) Right (or left) 
wheel, (2) March, and when the desired front has been obtained, 
(3) Forward, (4) MARCH, or if the intended change of direction be 
slight, the command is : Incline to the right (or left). 

In Column of Files. 
The detachment being in line at a halt, the column is formed and 
then moved by the commands : (1) Right (or left), (2) Face, (3) For- 
ward, (4) March. 



BEARER DRILL 247 

If in march, the commands are: (1) By the right (or left) flank, 
(2) March. 

To change direction in march: (1) Column right {ox left, or half 
right or left), (2) MARCH. 

To form line when marching: (1) By the right (or left) flank, 

(2) March, (3) Guide right (or left). 

To halt and form line: (1) Detachment, (2) HALT, (3) Left (or 
right), (4) Face. 

Or line may be formed from the column of files by the commands : 
(1) Left (or right) front into li?ie, (2) MARCH, (3) Detachment, 

(4) Halt, (5) Left (or right), (6) Dress, (7) Front. 

In Column of Twos or Fours. 

The column is formed and moved by the commands : (1) Twos (or 
fours) right (or left), (2) MARCH. 

This column changes direction by the commands given above for 
the column of files. 

To change into line : (1) Twos (or fours) left (or right), (2) MARCH, 

(3) Detachment, (4) Halt, (5) Right (or left), (6) DRESS, (7) FRONT; 
or line may be formed as from the column of files by the commands : 
(1) Right (or left) front into line, (2) MARCH, etc. 

Or, the column of fours at single rank distance as formed above may 
be closed to double rank distance : (1) Double rank distance, (2) Double 
tune, (3) March ; and the column thus formed having been marched 
as required may be spaced to single rank distance by the commands : 
(1) Form single rank, (2) MARCH; after which it is brought into line 
by: (1) Fours left {ox right), (2) MARCH, (3) Detachment, (4) Halt, 

(5) Right (or left), (6) DRESS, (7) FRONT. 

To form column of twos from column of files the commands are : 
(1) Form twos, (2) Left (or right) oblique, (3) MARCH; and the col- 
umn of twos is reformed into column of files by : (1) Right (or left) by 
file, (2) March. 

7. To rest the detachment in any of its formations : 

1. Detachment, 2. Rest. 

8 . To resume attention : 

1. Detachment, 2. Attention. 

9. To dismiss the detachment : The officer directs the stew- 
ard : Dismiss the detachment, when the junior officers fall out 
and the steward commands : 

1. Break ranks, 2. March. 



248 EMERGENCIES AND ACCIDENTS 



Inspection. 

10. The detachment being in line at a halt, the steward, drawing 
sword, salutes the surgeon in command, reports and takes his place on 
the right. 

The surgeon then draws sword, and, upon the approach of the in- 
spector, the surgeon commands : 

Detachment, ATTENTION ; 

and salutes the inspector, who acknowledges the salute and directs : 
Prepare your detachment for inspection. The surgeon then commands : 

Rear open order, MARCH, FRONT. 

11. At the first command, the steward steps briskly three paces to the 
rear to mark the new alignment of the file-closers, and the surgeon 
places himself three paces in front of the right file facing to the left. 
At MARCH, the junior officers step forward, each by the nearest flank, 
and place themselves opposite their places in line, three paces in front 
of the detachment; the men in rank dress to the right; the file-closers 
step backward and align themselves on the steward. The surgeon 
superintends the alignment of the junior officers and the rank, and the 
steward that of the file-closers ; the surgeon then verifies the alignment 
of the file-closers ; the junior officers and file-closers cast their eyes to 
the front as soon as their alignment is verified. At FRONT, the steward 
resumes his place in rank, and the men cast their eyes to the front. 

From his position on the right of the line of officers and facing to 
the left, the surgeon commands: 

Draw, Knife. 

12. At draw, each man provided with a knife grasps and slightly 
raises the sheath with the left hand and seizes the grip with the right, 
thumb to the rear and against the guard ; at KNIFE, he draws the hand 
quickly and raises the arm to its full extent, at an angle of about forty- 
five degrees, the knife in a straight line with the arm, then drops the 
arm naturally extended by the side, back of blade to the front, point 
down. Simultaneously the junior and acting stewards draw sword, and 
bring it to a carry. 

13. He then commands : 

Inspection, ARMS, 

and faces to the front. As soon as inspected he returns sword, and 
accompanies the inspector. When the latter begins to inspect the line, 
the junior officers face about and stand in place rest. 



BEAKER DRILL 



249 



Commencing on the right, the inspector now proceeds to minutely 
inspect the sword or knife, accoutrements, and dress of- each soldier in 
succession. Each man, as the inspector approaches him, brings his 
sword or knife vertically to the front, raising the hand as high as the 
neck and six inches in front of it, edge to the left, the thumb on the 
back of the grip; after a slight pause, he turns the wrist outward to 
show the other side of the blade, then turns the wrist back, and as the 
inspector passes on resumes the original position; after the inspector 
has passed he returns sword or knife without 
command. 

14. To return knife, each man grasps the 
sheath with the left hand, quickly raises up the 
right hand as high as the neck and six inches 
in front of it [as for inspection], then drops the 
point of the knife and sheathes the blade. 

15. This inspection completed, the surgeon 
again takes his post on the right, and com- 
mands : 

Inspection, Cases, 




and facing to the front, returns sword, and ac- 
companies the inspector as before. At Cases, 
the men make a half-face to the right ; those 
bearing dressing or medicine cases shift them 
to the front, the others take their dressing 
packets in the right hand, and all face again to 
the front ; as the inspector passes, the cases are 
opened so as to expose their contents, and the 
packets are shown. 

After the inspector has passed, each man 
makes a half-face to the right, closes and re- 
places the case or returns the packet, and faces Fjg _ 143.- Inspection, arms. 
to the front. 

16. If the members of the Hospital Corps are equipped with blanket- 
bags, the acting stewards so equipped then place themselves on the left 
of the rank ; the surgeon, from his post as before, commands : 

1. UnsUng, 2. Blanket-bag; 3. Open, 4. Blanket-bag. 

At the first command, each man makes a half-face to the right, and 
unfastens the hook of the right strap by seizing the D ring with the 
thumb and forefinger of the left hand passed under the blanket-bag; 
he then unhooks the strap with the right hand, and unslings the blanket- 
bag by passing the right forearm over the head ; at the same time he 
faces to the front, and, standing erect, holds it by the strap in front of 
the knees. At" the second command, he places the blanket-bag on the 



25O EMERGENCIES AND ACCIDENTS 

ground against his toes, the straps underneath, the great coat outward, 
and then stands at attention. At the fourth command, he opens the 
blanket-bag, turning the flap from him, the flap resting on the great- 
coat ; he then stands at attention. 

The blanket-bag having been inspected, the surgeon commands : 

1. Repack, 2. Blanket-bags. 

At the second command, each man repacks and fastens up his 
blanket-bag, leaving it in the same position as before opening it, and 
then stands at attention. He then commands : 

1. Sting, 2. Blanket-bags. 

At the command Sling, each man grasps the unhooked (right) strap 
with the right hand, the hooked left strap with the left hand, the back 
of the left hand to the right, raises the blanket-bag, and, standing erect, 
makes a half-face to the right. At the second command, he swings the 
blanket-bag over his shoulders, passing the left arm through the hooked 
strap, and carrying the right-hand strap over the head. He then brings 
this strap down over the right shoulder, makes a half-face to the left, 
and hooks the strap with the right hand, holding the D ring with the 
thumb and forefinger of the left hand, passed under the blanket-bag. 

The acting stewards resume their places in line, and each man stands 
at attention. 

17. The inspection being completed, the surgeon commands : 

Close order, MARCH. 

At March, the file-closers close to two paces and the junior officers 
resume their places in line. 

18. If there is no junior officer and the detachment is small, the ranks 
need not be opened, the junior or acting steward, if present, being placed 
on the right or left of the rank. 

19. In case any of the members of the detachment are mounted men, 
their horses and horse equipments will be examined after the inspection 
of the men dismounted. 

Muster. 

20. All stated musters of the detachment are, when practicable, pre- 
ceded by a minute and careful inspection. 

The detachment being in line with ranks open, the non-commissioned 
staff officers (if any) place themselves in the line of file-closers, on the 
left of the stewards, with swords at a carry. The surgeon, upon intima- 
tion of the mustering officer, commands : 

Draw, KNIFE; Attention to muster. 



LITTER DRILL 2$l 

He then returns sword, and hands a roll of the Hospital Corps de- 
tachment and non-commissioned staff to the mustering officer. The 
latter calls over the names on the roli ; each man, as his name is called, 
answers " Here," and returns sword or knife. Men without sword or 
knife are placed on the left, and, after answering, step forward one pace. 
The muster completed, the ranks are closed and the detachment is 
dismissed. 

21. After muster, the presence of the men reported in the hospital or 
on other duty is verified by the mustering officer, who is accompanied 
by the surgeon. 

LITTER DRILL. 

22. For the purposes of litter drill each set of four is a 
litter squad. The squads are numbered numerically from 
right to left : if there is an incomplete set, its members are 
directed to fall out as dummy wounded or for special duty as 
may be required. 

23. No. 1 is chief of squad; No. 4 carries the dressing 
case. 

24. The officer in command will make such changes in the 
personnel of the sets of four as he deems advisable. The 
selection of No. 1 should be determined by the intelligence 
and experience of the men ; No. 4 should be as near in size 
as possible to No. 1, and No. 2 to No. 3. The fours are then 
counted again, if necessary. The men having once been 
placed in this manner should always fall in thereafter in their 
assigned places. 

25. The officer then commands : 

Count, Squads, 

when each chief calls out the number of his squad, in numeri- 
cal order from right to left. 

26. Having assigned the medical officers and stewards to 
appropriate duties, he commands : 

Procure litter, March, 

when No. 3 of each squad steps one pace to the front, faces 
as required, proceeds by the nearest route to the litters, takes 
one, and, returning with it on the right shoulder at a slope of 
at least forty-five degrees, canvas down, resumes his place by 



>52 



EMERGENCIES AND ACCIDENTS 



passing through his interval a yard to the rear, facing about, 
and stepping into line. 

In procuring, as well as in returning the litters, the men 
follow each other in the numerical order of their squads. 

He may then form the line into column of twos or fours for 
marching, or may proceed with the instruction of the squads 
in litter drill. 

DRILL WITH THE CLOSED LITTER. 




Fig. 144. — Carry, litter. 1 



27. To carry litter from position in line, the order is 
given : 

Carry, Litter, 

when No. 3 places his left hand upon the litter at the level 
of the shoulder, and pressing the lower handles backward, 
with the right hand brings the upper handles forward and 

1 In this cut the litter handles have been fastened together, making it pos- 
sible to carry the litter by the upper ones only. Ordinarily, the bearers (as 
stated in par. 34) grasp the lower handles, which support the upper ones and do 
away with the necessity for having them fastened together. 



LITTER DRILL 253 

downward until the litter is in a horizontal position, canvas 
to the left ; meanwhile the other numbers step directly to the 
front, No. 2 until he is opposite the front handles, which he 
seizes with his left hand, and Nos. 1 and 4 until they are 
opposite the centre of the litter. 

28. The line of litters may be manoeuvred by the commands already 
given [par. 6] to march forward or backward, to side step at a halt, to 
pass from quick to double time or the reverse, and to change directio?i 
during a march. 

29. To inarch to the rear, a movement which may be occasionally 
required, the commands are : 

To the rear, MARCH, 

when all the members execute an about, No. 2 left, the others right, 
the two bearers meanwhile transferring the handles from One hand to 
the other. On halting, the members face about to the front without 
command. 

30. At a halt, the line of litters wheels on tne front bearer of the right 
(or left) squad as a fixed pivot. 

31. In changing direction during a forward march, the line wheels on 
the right or left squad as a movable pivot until the desired direction is 
obtained. 

32. A single squad, apart from others, is faced as a unit, as follows : 

Litter right (or left), FACE, 

when No. 2 steps off to the right and No. 3 to the left, both describing 
a quarter of a circle, so as to make the litter revolve horizontally on its 
centre until both face to the right — Nos. 1 and 4 maintain their relative 
positions opposite the centre of the litter. 

33. In marching the line by its flank it is converted into a column of 
litters (single), but this cannot be effected by the commands applicable 
to men without litters, or with litters at a shoulder, because the front 
occupied by the squad does not give enough of space to enable each 
litter to face — a greater interval between the squads is needful. 

To face the squads of a detachment so as to march them in column 
of litters or to increase the intervals between the squads for purposes of 
drill or service, the commands are : 

1. By the right (or left) flank, 2. Take one yard (or more) intervals, 
3. March. 

At the second command the first litter faces to the right on a movable 
centre, so as to gain sufficient ground ; and at March, advances in the 



254 EMERGENCIES AND ACCIDENTS 

new direction, each succeeding litter facing in the same manner as soon 
as its flank is clear, and following one yard (or more) in rear of the 
squad on its right until the last squad has obtained its interval, when 
the instructor continues the march or halts the command and forms 
line, as may be desired. 

34. If a line is to be formed the commands are : 

Detachment, HALT; Left (or right), FACE; or 
By the left (or right) flank, MARCH ; Detachment, HALT. 

35. The litters being shouldered (par. 47) and rank formed, the 
squads may be closed again by the commands : 

1. By the right (or left) flank, 2. Close intervals, 3. MARCH, 

when the right squad standing fast, the other squads face to the right, 
close up and successively halt, and face to the front. 

36. The line of litters, at close or open intervals, may be formed in 
column of twos, by the commands : 

Litters, Twos right (or left) , MARCH, 

each two wheeling on the front bearer of the right (or left) squad as a 
pivot. 

37. The column may be formed and march to the front by the 
commands : 

Right (or left) forward : Twos right (or left), MARCH. 

38. The line formation is recovered by : 

Litters, Tzvos left (or right), MARCH, Litters, HALT, Right (or left), 
Dress, Front. 

39. Or by: 

Left (or right) front into line, MARCH, Litters, HALT, Right (or left), 
Dress, Front. 

40. An about with the litters at open intervals or in single column is 
executed by the commands : 

Litters, About, FACE, 

when Nos. 2 and 3 step off as in facing to the right (par. 32), but con- 
tinue the movement until both face to the rear, the other numbers 
maintaining their relative positions opposite the centre of the litter. 



LITTER DRILL 



255 



41. To change bearers the commands are given : 

Change Posts, March, 

when No. 1 takes position as No. 3, and No. 4 as No. 2, 
while Nos. 3 and 2 step to the left and right, respectively, 
into the vacated positions ; the change is effected without 
halting, if in march. 

42. The chief of squad continues to exercise command from 
whatever position he may occupy. 

43. When the bearers are again changed the members of 
the squad resume the positions as at Carry Litter (par. 27). 

44. To ground the litter from the position of carry, the 
order is given : 

Ground, Litter, 

when Nos. 2 and 3 lower it to the ground, lengthwise between 
the files, canvas up. 




Fig. 145. — Ground, litter. 

45. Posts at the grounded litter may at any time be re- 
covered by the commands : 



256 



EMERGENCIES AND ACCIDENTS 



when 



At litter, Posts, 

the numbers take posts, No. 2 on the right of the front 
handles, No. 3 on the left of the rear handles 
and close to them, and Nos. 1 and 4 respect- 
ively on the right and left of the litter at its 
midlength and one pace from it, all facing 
to the front. This is the invariable posi- 
tion taken by each number at the above 
commands, whatever may have been his 
previous position or duty. 

46. To carry Utter when grounded: At 
the commands : 

Cany, Litter, 

Nos. 2 and 3 grasp the litter and raise it 
from the ground to the position of carry. 

47. To shoulder litter from the position 
of carry : At the commands : 

Shoulder^ Litter, 




Fig. 146. — Diagram, 
showing the posi- 
tion of the bearers 
at litter posts. 



No. 2 raises- his end to assist 
No. 3, who places the litter on his 
right shoulder, canvas down, sup- 
porting it at an angle of 45 degrees 
by the right arm and hand ; mean- 
while the other numbers step back- 
ward and align themselves upon 
him in regular order. 

48. To bring the litter to an 
order front a shoulder : At the 
commands : 

Order, Litter, 

No. 3 brings it to a vertical posi- 
tion and drops the lower handles 
to the ground, supporting it by the 
right hand at the level of the 
shoulder (Fig. 148). 




Fig. 147. — Shoulder, litter. 
Otis litter was used here. 



LITTER DRILL 



257 



49. To shoulder litter from the position of order : At the 
commands: shoulder, Litter, 

No. 3 grasps the litter with both hands well below its middle, 
fingers to the front, and raises it to the shoulder. 

50. In the field the litter should always be 
carried closed and only opened on reaching 
the patient. 

51. To open the litter : At the commands : 

Open, Litter, 

the strapped litter, if at a carry, is first lowered 
to the ground, when Nos. 2 and 3 unbuckle the 
straps and fasten the free end of each to the 
pole, then grasp the ends of the right pole with 
their right hands and rise. This leaves the 
litter suspended longitudinally, canvas to the 
left. They then extend the braces, and sup- 
porting the litter horizontally by both poles 
lower it to the ground and resume the position 
of attention, each between the handles of his 
end of the litter. 

52. This is the position of the squad when 
at litter posts with the open litter. 

53. If the litter be merely folded (that is, unstrapped), it is 
first brought to a carry, if on the ground (par. 46), when 
Nos. 2 and 3 drop the left pole, extend the braces, lower the 
litter, and take position as before. 

54. To close the litter, the commands are given : 

Close, Litter, 

when Xos. 2 and 3 side-step around the handle to the right 
and left, respectively, face inwards, stoop, and with their right 
hands raise the litter by the right pole. They then fold the 
braces and support the closed litter with the hand grasping 
the lower handles when they face to the front. 

1 In this cut, the canvas has been folded about the litter, so that the bottom 
does not show, as in Fig. 147, where it has simply been folded upon the top to 
form a cushion for the shoulder. 




Fig. 148. — Order, 

litter.! 



258 EMERGENCIES AND ACCIDENTS 

55. The litter is strapped by Nos. 2 and 3 at the termina- 
tion of the exercises. 

56. The detachment being in line at a halt, with the litter 
at a shoulder, at the commands : 

Return Utter, March, 

No. 3 steps one pace to the front, faces as required, and 
proceeds by the nearest route to the place designated for the 
litters, where he leaves it, and, returning, resumes his position 
in line. 



DRILL WITH THE OPEN OR LOADED LITTER. 

57. To lift the Utter. — The squad being in position with 
the men at Utter posts (par. 52), the commands are given : 

Prepare to lift, Lift. 

At the first command Nos. 2 and 3 slip the loops of their 
slings over the handles, beginning with the left, and grasp 
the handles ; at the second command they rise slowly erect. 

58. At the order: 

Forward, March, 

the bearers step off, No. 2 with the left. No. 3 with the right 
foot, taking short sliding steps of about 20 inches, to avoid 
jolting and to secure a uniform motion of the litter. Nos. 1 
and 4 step off with the left foot. 

59. The so-called single step, which is by far the easiest 
for the patient, but which is acquired with difficulty, may also 
be practised. No. 2 steps off with the left foot and No. 3 
follows with his right an instant later and before No. 2 has 
planted his right ; No. 2\s right foot next touches the ground, 
and is immediately followed by No. 3's left. 

60. To lower the litter, the order is given : 

Lower, Litter, 

when Nos. 2 and 3 slowly lower the litter to the ground, 
release the slinks from the handles, and stand erect. 



LOADING THE LITTER 



259 



61. The open litter should be lifted and lowered slowly 
and without jerk, both ends simultaneously, the rear bearer 
moving in accord with the front bearer, so as to maintain the 
canvas horizontal ; in fact the open litter should be handled 
for purposes of drill as if it were a loaded litter. 

62. For drill with the loaded litter dummy patients are 
directed to lie down wherever required, and each squad is 
separately exercised in loading, marching, passing obstacles, 
anloading, etc., under the orders of its chief or an instructor, 

63. To cease drilling and reform the detaclwient, the officer 
in command directs the first squad to resume its original 
position in line with loaded litter, 
whereupon the other squads at once 
proceed, in numerical order, to their 
places in line with loaded litter; the 
patients are then directed to rise and fall 
out. 

TO LOAD THE LITTER. 

64. The litters being lifted (par. 57), 
or at a carry (pars. 27, 46), at the com- 
mands : 

Take post to load, March, 

each chief assumes entire charge of his 
squad, and proceeds independently. 
The squad advances towards its as- 
signed patient, and halts one yard from 
his head or feet, preferably his head, 
and in a line with his body. The litter 
is now opened (if it has been carried 
closed, as is the rule in field service — 
par. 50), and lowered. 

65. The chief of squad then com- 
mands : 

Stand to patient, right (or left). March. 

66. With litter at the head of the patient, if the command 
is right. Nos. 2. 1. and 3. proceeding by the right, take po- 




Fig. 149. — Relations in stand- 
ing to patient, right and 
left, with the litter at the 
patient's head. 



260 



EMERGENCIES AND ACCIDENTS 




sition, No. 2 at the right knee, No. i at the right hip, and No 
3 at the right shoulder ; while No. 4, passing by the left, takes 
position by the left hip opposite No. 1, all facing the patient. 
6y. If the command is left, Nos. 2, 4, and 3, proceeding by 
the left, take position, No. 2 at the left knee, No. 4 at the left 
hip, and No. 3 at the left shoulder; 
while No. 1, passing by the right, 
takes position by the right hip oppo- 
site No. 4, all facing the patient. 

68. Should the litter be placed at 
the feet of the patient, Nos. 1 and 4 
cross each other on their way to their 
respective sides of the patient. 

69. It will be seen from the above 
that, whether the command is right 
or left, the positions of Nos. 1 and 4 
are invariable, No. 1 at the right hip, 
No. 4 at the left hip ; and that the 
positions of Nos. 2 and 3 are always 
at the knee and shoulder, respectively, 
on the right or left of the patient, as 
the command may be ; if right, they 
are on each side of No. 1 ; if left, they 
are on each side of No. 4. 

70. In field service, Nos. 1 and 4 
should run ahead and take position 
at the hip on their respective sides ; 
they remove the arms and accoutre- 
ments of the wounded man, and ex- 
amine him to determine the site and nature of the injury ; 
and having administered restoratives, if required, and applied 
such dressings or splints as are needful or available, — in which 
duty all the members of the squad may be made use of, — the 
chief of squad commands: Stand to patient, etc. (par. 65). 

71. As a rule, the command should be right or left, accord- 
ing as the right or left side of the patient is injured, so that 
by having the three bearers on that side a better support may 
be given to the wounded parts. 



1 



/ 4 



1_£_ 



/ 



Fig. 150. -- Relations in stand- 
ing to patient, right and 
left, with the litter at the 
patient's feet. 



LOADING THE LITTER 26l 

72. Prepare to Lift. 

At this command all the bearers kneel on the right knee 
if on the right of the patient, and on the left knee if on his 
left. No. 2 passes both arms under the patient's legs, care- 
fully supporting the fracture if there be one. Nos. 1 and 4 
pass their arms under his hips and thighs side by side, not 
locking hands. No. 3 passes one arm under his neck to the 
further armpit, with the other supporting the nearer shoulder. 

73- Lift. 

At this command all lift together slowly and carefully, and 
place the patient upon their knees. As soon as the patient is 
firmly supported there, the bearer on the free side (No. 1 or 
4) relinquishes his hold, passes quickly and by the shortest 




Fig. 151. — Lift. 

line to the litter, which he takes up by the middle, one pole 
in each hand, and returning rapidly places it under the patient 
and against the bearers 1 ankles. 

74. Lower, Patient. 

The free bearer, No. 1 or 4, stoops and assists the other 
members in gently and carefully lowering the patient upon 
the litter. The bearers then rise and at once resume their 
positions at litter posts (par. 52). 

75. In the field when the ground on which the patient lies 
is such that the litter cannot be placed directly under him, it 



262 



EMERGENCIES AND ACCIDENTS 



should be placed as near to him as possible and preferably in 
a direction parallel to or in a line with the body. 

76. It may sometimes be necessary to carry the patient to 
the litter instead of the litter to the patient. The bearers 
having secured their hold, as before described (par. 72), 




Fig. 152. — Placing the patient on the litter after carrying him to it. 

rise together and move slowly and steadily to the litter. 
If the distance be great, it will be best for Nos. 1 and 4 to 
interlock fingers, palms up. 



POSITION OF PATIENT ON THE LITTER. 

yy. The position of a patient on the litter depends on the 
character of his injury. An overcoat, blanket, blanket-bag, 
knapsack, or other suitable and convenient article, should be 
used as a pillow to give support and a slightly raised position 
to the head. If the patient is faint, the head should be kept 



LITTER DRILL 263 

low. Difficulty of breathing in wounds of the chest is relieved 
by a sufficient padding underneath. In wounds of the abdo- 
men, the best position is on the injured side, or on the back 
if the front of the abdomen is w r ounded ; the legs in either 
case being drawn up, and a pillow or other available object 
placed under the knees to keep them bent. 

yS. In an injury of the upper extremity, calling for litter 
transportation, the best position is on the back with the in- 
jured arm laid over the body, or suitably placed by its side, 
or on the uninjured side, with the wounded arm laid over the 
body ; while in injuries of the low r er extremity the patient 
should be on his back, or inclining toward the wounded side. 
In cases of fracture of either lower extremity, if a splint can- 
not be applied, it is always well to bind both limbs together. 

TO CHANGE BEARERS. 

79. The litter having been brought to a halt and lowered, 
the order is given : 

Change posts, March, 

when Nos. 1 and 4 relieve the bearers, as in par. 41. 

80. The position of the men under this order holds good 
until posts are again changed, except in the case of such a 
disarrangement of the squad as calls for their reformation by 
the command : At litter, Posts, when all take position in 
accordance with the requirements of par. 52. 

GENERAL DIRECTIONS. 

81. In moving the patient either with or without litter, 
every movement should be made without haste and as gently 
as possible, having special care not to jar the injured part. 
The command : Steady, will be used to prevent undue haste 
or other irregular movements. 

82. The loaded litter should never be raised nor lowered 
without orders. 

83. The rear bearer should watch the movements of the 
front bearer, and time his own by* them, so as to insure ease 
and steadiness of action. 



264 EMERGENCIES AND ACCIDENTS 

84. The number of steps per minute will depend on the 
weight carried, and other conditions affecting each individual 
case. 

85. The handles of the litter should be held in the hands 
supported by the slings at arms-length, and only under the 
most exceptional conditions should the handles be supported 
on the shoulders. 

86. The bearers should keep the litter level, notwithstand- 
ing any unevenness of the ground. 

87. In making ascents the rear handles should be raised to 
bring the litter to the proper level ; and if the ascent is steep, 
No. 1 should come to the assistance of No. 3 in raising it to 
the shoulder, if necessary. 

SS. In making descents the front handles should be raised, 
and if the descent is steep No. 4 should aid No. 2 in raising 
them. 

89. As a rule, the patient should be carried on the litter 
feet foremost ; but in going up hill, his head should be in 
front. In case of fracture of the lower extremities, he is 
carried up hill feet foremost and down hill head foremost to 
prevent the weight of the body from pressing down on the 
injured part. 

90. For purposes of drill, a tag of red or white cotton or 
flannel may be attached to dummy wounded, to indicate the 
site and character of the injuries to be cared for. 

TO PASS OBSTACLES. 

91. A breach should be made in a fence or wall for the passage of 
the litter, if there be no gate or other opening ; but should it be neces- 
sary to surmount the obstacle, Nos. 4 and 1 take hold of the poles each 
on his own side, thus permitting No. 2 to get- over, when the front 
handles are passed to him ; Nos. 4 and 1 then follow, and taking hold 
near the rear handles support the litter until No. 3 has crossed. All 
then resume their positions and continue the march. 

92. The passage of a deep cut or ditch is effected in a similar manner ; 
Nos. 1 and 4 bestride or descend into the cut and support the litter 
near its front handles until No. 2 has crossed and resumed his hold, 
when they then give support near the rear handles until No. 3 has 
crossed. 



LITTER DRILL 



265 



93. If the cut or ditch be wide, the litter is halted and lowered with 
the front handles (or feet) near the edge ; Nos. 4 and 2 descend and 
advance the litter, keeping it level until the rear handles (or feet) rest 
upon the edge, when Nos. 3 and 1, who 
have assisted in this movement, descend 
and resume the support of their respec- 
tive handles ; the ascent on the other 
side is made by Nos. 4 and 2 resting 
their handles on the edge, ascending and 
advancing the litter until 
., , m its rear handles rest upon 
the edge, when 3 and 1 
ascend, and the march is 
resumed. 




Fig. 153. — By four, carry litter, — used in carrying a patient upstairs. 



94. In crossing a running stream or broken or otherwise difficult 
ground, Nos. 1 and 4 give support on their respective sides of the litter, 
or take full care each of the handle of his own side, — No. 4 in front, 
No. 1 in rear. In the latter case, the commands would be: By four, 
Carry Litter. 



266 



EMERGENCIES AND ACCIDENTS 



TO LOAD WITH REDUCED NUMBERS, 

95. Should only three bearers be available, the litter is 
placed as usual at the head of the patient; Nos. 2 and 3 
proceed to their proper positions at the knee and shoulder 
of one side, while No. 1 stands at the hip 4 of the opposite 
side. The patient, having been lifted by the three bearers, 
is supported on the knees of Nos. 2 and 3, while No. 1 places 
the litter in position under him. 




Fig. 154. — Carrying the patient to the litter, with but three bearers. 

96. Another method for three bearers, when it is necessary 
to carry the patient to the litter, is as follows : 

Nos. 2 and 3 take position opposite the knee and hip re- 
spectively, while No. 1 stands by the hip opposite No. 3. As 
with four bearers, Nos. 2 and 3 should preferably be directed 
to the wounded side. At the usual commands, Nos. 1 and 3 
stoop and, raising the patient to a sitting position, place each 
one arm and hand around the back, and interlock the fingers 
of the other hand, palms up, under the upper part of the 
thighs. The patient, if able, clasps his arms around their 






UNLOADING THE LITTER 267 

necks. No. 2 supports the lower extremities with both arms 
passed under them, one above, the other below, the knee. 

97. If only two bearers are available (Nos. 2 and 3), the 
patient is necessarily always carried to the litter; No. 2 pro- 
ceeds by the right and No. 3 by the left, and take position on 
opposite sides of the patient near his hips. They lift patient 
as directed (par. 96) for Nos. 1 and 3, the legs remaining un- 
supported, and carry him head foremost over the near end 
and length of the litter. 

98. In case of a fractured lower extremity, the two bearers 
must take hold of the patient on the injured side, No. 2 sup- 
porting both lower extremities, while No. 3 supports the body, 
the patient clasping his arms around his neck. 

TO UNLOAD THE LITTER. 

99. To unload with four or three men, they stand to patient 
as in loading ; at the commands : Prepare to lift, Lift, they 
raise him upon the knees, the free bearer removes the litter, 
and at Lower, Patient, they lower him carefully to the ground. 

100. With two men, they form a two-handed seat and lift 
the patient off the litter ; or, in case of fracture, they stand 
on the same side and, stooping, lift him and take two steps 
backward to clear the litter, when they lower him to the 
ground. 

TO TRANSFER PATIENT FROM LITTER TO BED OR ANOTHER 
LITTER. 

101. With four men, the litter being placed close along- 
' side the bed (on either side), the patient's head correspond- 
ing to that of the bed, he is taken from the litter and sup- 
ported on the knees in the usual manner. The free bearer 
then removes the litter, and the others having risen take a 
step forward and lower the patient upon the bed. 

102. With three men, the litter is placed at the foot of the 
bed, and in line with it ; the three bearers, all on one side, 
lift the patient without kneeling, and move cautiously by side 
steps to the bedside. 



268 



EMERGENCIES AND ACCIDENTS 



103. With two men, the litter is placed at the foot of the 
bed as before, and the patient carried cautiously by side steps, 
or carried head foremost over the foot of the bed on a two- 
handed seat. 

IMPROVISATION OF LITTERS. 

104. Many objects can be used for this purpose : 




Fig. 155. — Litter of two poles thrust through two grain sacks. 

Camp cots, window blinds, doors, benches, boards, ladders, 
etc., properly padded. 

Litters may be made with sacks or bags of any description, 




Fig. 156. — Litter of three coats and four rifles. 

if large and strong enough, by ripping the bottoms and passing 
two poles through them, and tying cross pieces to the poles 



IMPROVISED LITTERS 



269 



to keep them apart ; two, or even three, sacks placed end to 
end on the same poles may be necessary to make a safe and 
comfortable litter. 

Bedticks are used in the same way by slipping the poles 
through holes made by snipping off the four corners. 

Pieces of matting, rug, or carpet trimmed into shape may 
be fastened to poles by tacks or twine. 




Fig. 157. — Litter formed by a single pole and a hammock. 



Straw mats, leafy twigs, weeds, hay, straw, etc., covered or 
not with a blanket, will make a good bottom over a frame- 
work of poles and cross sticks. 

Better still is a litter with bottom of ropes or raw-hide strips, 
whose turns cross each other at close intervals. 

105. But the usual military improvisation is by means of 
two rifles and a blanket. 

One-half of the blanket is rolled lengthwise into a cylinder, 
which is placed along the back of the patient, who has been 
turned carefully on his side. The patient is then turned over 
on to the blanket and the cylinder unrolled on the other 



270 



EMERGENCIES AND ACCIDENTS 



side. The rifles (with bayonets fixed, if at hand) are then 
laid on the ground under the side edges of the blanket, 
muzzles to the front and somewhat converging, butts to the 
rear or head of the patient, and are rolled tightly in the 
blanket, each a like number of rolls, until the side of the body 
of the patient is reached, when they are turned hammers 
downward. 

Two bearers may carry the wounded man in this impro- 
visation, but it is better, whenever possible, that four men 
should do so — two on each side, firmly grasping the blanket, 
over the rifle. 



METHODS OF REMOVING WOUNDED WITHOUT 
LITTERS. 

FOR ONE BEARER. 

1 06. While it is not desirable that one bearer should, ordi- 
narily, be required or permitted to lift a patient unassisted, 
emergencies may arise when a knowledge of proper methods 
of lifting and carrying by one bearer is of the utmost value. 

107. A single 
bearer may carry 
a patient in his 
arms; on his 
back, or across 
his shoulder. 

To bring the 
patient into any 
of these posi- 
tions, the first 
steps are as fol- 
lows : 

The bearer, 
turning patient 
on his face, steps 
astride body, facing toward the head, and with hands in his 
armpits lifts him to his knees, then clasping hands over the 
abdomen, lifts him to his feet and places the patient's left 




Fig. 158. — Lifting the patient from the ground. 



CARRYING BY ONE BEARER 



271 



arm around his (the bearer's) neck, the patient's left side 
resting against his body. 

108. From this position the bearer proceeds as follows : 

To lift the patient in his arms 1 

The bearer, with his right 
arm behind patient's back, 
passes his left under thighs 
and lifts him into position. 

109. To place patient astride 

of back : 

The bearer shifts himself to 
the front of patient, back to 





Fig. 159. — Preliminary position, the same 
in ail cases. 

him, stoops, and grasping 
his legs above the knees 
brings him well up on his 
back. 

no. To place patient 
across back : 

The bearer with his left 
hand seizes the left arm of 
the patient and draws it 
down upon his left shoulder, then, shifting himself in front, 
stoops and clasps the right thigh with his right arm passed 
between tne legs, when he rises. 



Carrying patient astride of back. 



2>]2 



EMERGENCIES AXD ACCIDENTS 



in. To place patient 
across shoulder : 

The bearer faces pa- 
tient, stoops, places his 
right shoulder against 
the abdomen, and clasps 
the right thigh with the 
right arm passed between 
the legs ; he then grasps 
the patient's right hand 
with his left, and draws 
the right arm down upon 
his left shoulder until the 
wrist is seized by his own 
right hand : lastly, he, 
with his left hand, grasps 
the patient's left and 
steadies it against his 
side, when he rises, 

112. In lowering pa- 
tient from these posi- 
tions the motions are reversed. Should a patient be wounded 
in such manner as to require these mo- y s~^ 

tions to be conducted from his right 
side, instead of left as laid down, the 
change is simply one of hands — the 
motions proceed as directed, substi- 
tuting right for left, and vice versa. 

FOR TWO BEARERS. 

By the two-handed seat : 

113. The patient lying on the ground, 
at the command : 

Form two-handed seat, 

the two bearers take position facing 

each other, No. 1 on the right and Fig. 162. —Two-handed seat. 




Fig. 161. — Carrying patient across shoulder. 




CARRYING BY TWO BEARERS 



273 



No. 2 on the left of the patient, near his hips. At the com- 
mand : 

Prepare to lift, 

they raise the patient to a sitting posture, pass each one hand 
and arm around his back, while the other hands are passed 
under the thighs, palms up, and the fingers interlocked. At 
the command : 

Lift, 

both rise together. If the patient has to be so carried for a 
long distance, the bearers should grasp each others wrists 
under the patient's thighs. In marching the bearers should 
break step, the right bearer starting with the right foot and 
the left bearer with the left foot. 



Note. — A method, which is of particular value because of the ease with 
whicli the bearer may preserve his equi- 
librium and because it leaves one hand 
free for use in climbing ladders, carrying * 

arms, etc., is as follows: 





Fig. 163. — Lifting over the shoulder. 



Fig. 164. — Carrying patient over shoulder 



To place patient over shoulder. 

From the preliminary position, the bearer passes his right hand between the 
patient's thighs and, turning to face the patient, places his right shoulder against 
the patient's abdomen, permitting the patient to fall over his right shoulder (Fig. 
162), and, with his right hand, grasping the patient's right hand — which has 
been drawn under his left armpit — rises to his feet (Fig. 163). — Author. 



274 



EMERGENCIES AND ACCIDENTS 



By the four-handed seat : 

114. This method is applicable when the patient has con- 
siderable strength and the use of his arms. At the command : 



Form four-handed seat, 

the two bearers take position as 
in par. 113. At Prepare to lift 
they stoop, pass their hands under 
the patient's buttocks and form a 
four-handed seat, each bearer 
grasping his right forearm just 
above the wrist with the left hand, 
and then grasping the other bear- 
er's disengaged forearm with his 
own disengaged hand, palms down. 
At the command Lift, both rise 
together, the patient steadying 
himself by passing his arms around 
the bearers 1 necks. 1 




Fig. 165. — Four-handed seat. 



By the extremities : 

115. This method requires no effort on the 
patient ; but it is not applicable to 
severe injuries of the lower extremi- 
ties. One bearer stands by the pa- 
tient's head, the other between his 
legs', both facing toward the feet. 
At Prepare to lift, the rear bearer 
clasps the wounded man around the 

1 Note. — A seat frequently used — trie three- 
handed seat — is a modification of the four-handed 
seat and is formed in a very similar manner, the 
left-hand bearer grasping his own right forearm 
with his left hand and the other bearer's right 
forearm with his right hand; the right-hand 
bearer grasps the other bearer's right shoulder 
with the left hand and his left forearm with 
the right hand (Fig. 166). In this way a seat 
is formed with a back. — Author. 




Fig. 166. The thiee-ha 



RIFLE SEATS 



275 




body under the arms, while the front bearer passes his arms 
from the outside under the flexed knees. At Lift both 
bearers rise together. 

By the rifle seat : 

116. A good seat may be 
made by running the bar- 
rels of two rifles through 
the sleeves of an overcoat, 
so that the coat lies back 
up, collar to the rear. The 
front bearer rolls the tails 
tightly around the barrels 
and takes his grasp over 
them : the rear bearer 
holds by the butts, ham- 
mers down. 

117. A stronger seat is 
secured when the gun- 
slings are used. The slings are unhooked and let out to their 
full length from the rear swivel. The rifles are then placed 
upon the ground, parallel to each other, but with the hammers 

outside, at a distance of about 20 inches. Each 
sling is passed around the opposite rifle, then 
around its own. and lastly hooked to the front 
swivel of the other rilie, thus forming a seat 
20 inches wide and 2 feet long, on which the 
patient sits with his back against the rear 
bearer, his legs hanging over outside, and the 
hollow of his knees resting upon the barrels. 
118. A quicker way to prepare a rifle seat, 
when a twist of the slings is not objectionable, 
is as follows : 1 

Two men with the slings of their rifles loosened, as for 
carrying on the back, face each other and bring their pieces 
to a -present arms.'" Thereupon Xo. 1 seizes the sling of 



Fig. 167. — Carriage by the extremities. 




Fig. 168. — Litter of 
rifles and overcoat. 



1 Method of Captain Norton Strong, U.S.A. 




276 EMERGENCIES AND ACCIDENTS 

No. 2's rifle with the right hand, lifts his own rifle with the 
left hand, and passes the butt through the sling from left to 
right, straightening the piece as soon as the hammer has 
cleared the sling. No. 2 grasps the sling of No. i's rifle with 

the right hand, and, depressing 
the muzzle of his own piece, 
passes it through the sling he 
holds, from left to right, straight- 
ening the piece as the sling is 
cleared. 

Fig. 169. —The rifle seat. The pieces now being at the 

original " present," the butts are 

lowered to the ground, the left hand of each man being 

brought to the muzzle of his gun. No. 2 grasps the muzzles, 

No. 1 stoops and secures the butts. 

FOR THREE BEARERS. 

119. See paragraphs 95 and 96. 

TO PLACE A SICK OR WOUNDED MAX ON HORSEBACK. 

120. In emergencies it may be needful to carry a disabled 
man on horseback. The help required to mount him will 
depend on the site and nature of his injuries ; in many cases 
he is able to help himself materially. If he be entirely help- 
less, five men are required to get him into the saddle — one 
to hold the horse, the others to act as bearers. 

The horse, blind-folded, is held in position at right angles 
to the patient, who lies on the ground on his back on the 
near side, with his head toward the horse. Nos. 2, 1, and 
4 take position as at stand to patient, left, No. 2 at the 
ankles on the left, and the others at the right and left hip 
respectively, while No. 3 stands on the off side of the horse 
ready to grasp the shoulders of the patient when they are 
brought within his reach. At P?'epare to lift, No. 2 passes 
both arms under the legs ; 1 and 4 place each hand under the 
corresponding buttock and the other under the shoulders, 
not locking hands. At Lift, the patient is carefully raised 



LOADING THE PATIENT ON HORSEBACK 277 

and carried over the horse until his seat reaches the saddle. 
No. i now goes quickly around the horse's head to the off 
side, and the patient is made to pivot in the saddle, Nos. 3 
and 4 on either side supporting and at the same time depress- 
ing his back, while No. 2 raises the legs until the right leg 
comes within reach of No. 1, when each foot is carried down- 
ward for support in its stirrup. 

121. To dismount, the process is reversed: Nos. 3 and 4 
standing on each side of the horse depress the body of the 





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6 ft-^HR jtnl - * 




r* \ 




■/ 


, - ■'..".■" V . - 





Fig. 170. — Placing an injured man on horseback, 



patient backward, while 1 and 2 raise the legs. The patient 
is then pivoted to the left, No. 1 passing the right leg over the 
pommel to No. 2 and then taking position on the near side to 
lower the patient to the ground or litter, as the case may be. 

122. To mount with the assistance of three men : The three 
bearers take position by the patient, as above, on the near 
side of the horse and raise him into the saddle, when, if the 
legs are not injured, No. 2 relinquishes them to take post on 
.the off side and aid No. 1 in adjusting them; but if the legs 
are injured, No. 1 should take post on the off side to aid 
No. 2 in this part of the work, the other member of the squad 
meanwhile supporting the body in the saddle. 



278 



ACCIDENTS AND EMERGENCIES 



123. With only two bearers it is possible, but difficult, to 
place a helpless man on horseback : The patient having been 
raised into the saddle by both bearers, one of them goes to 
the off side to aid in effecting his adjustment. 

124. The patient once mounted should be made as safe 
and comfortable as possible. A comrade may be mounted 
behind him to hold him and guide the horse ; otherwise, a 
lean-back must be provided, made of a blanket roll, a pillow, 
or a bag filled with leaves or grass. If the patient be very 
weak, the lean-back can be made of a sapling bent into an 
arch over the cantle of the saddle, its ends seeurely fastened, 
or of some other framework to which the patient is bound. 

THE TRAVOIS. 

125. The travois consists of a litter drawn by one animal, 
the rear handles trailing on the ground. It is the ordinary 




Fig. 171. — The travois. 



Indian conveyance for patients and baggage, and being such, 
may be considered the best method of improvising means of 
transport in our western country The travois requires only 
one animal and two men, one to lead the animal, the other to 
watch the litter and be ready to lift its rear poles when pass- 
ing over obstacles, crossing streams, or going up hill. 

It may be improvised by cutting poles 15 feet long and 
about 2 inches in diameter at the small end. These poles 
are laid parallel to each other, small ends to the front and 2 J 



TRAVOIS AND HORSE LITTERS 



279 



feet apart ; the large ends about 3 feet apart, and one of them 
projecting 8 or 10 inches beyond the other. The poles are 
connected by a crossbar about 6 feet from the front ends 
of the poles, and another about i\ feet from the rear ends, 
each notched at its ends and securely lashed by its notches 
to the poles. Between the cross-pieces the litter-bed, 6\ feet 
long, is filled in with canvas, blanket, etc., securely fastened 
to the poles and crossbars, or with rope, lariat, rawhide strips, 
etc., stretching obliquely from pole to pole in many turns 
crossing each other to form the basis for a light mattress or 
improvised bed ; or a litter may be made fast between the 
poles to answer the same purpose. The front ends of the 
poles are then securely fastened to the saddle of the animal. 

THE TWO-HORSE LITTER. 

126. The two-horse litter consists of a litter with long 
handles used as shafts for carriage by two horses, or mules, 




Fig. 172. — Two-horse litter. 



one in front, the other in rear of the litter. It accommodates 
one recumbent patient. On a good trail it is preferable to 
the travois, as the patient lies in the horizontal position, and, 
in case of fractured limbs, they can easily be secured against 
disturbance. The great disadvantage of this litter is that it 
requires two animals and three men for the carriage of each 
patient, one to attend to the disabled man, and the others 
to watch over and guide the movements of the animals. This 



280 EMERGENCIES AND ACCIDENTS 

litter may be improvised in the same manner as the travois, 
only the poles should be 16J feet long, and the crossbars 
forming the ends of the litter-bed should be fastened 5 feet 
from the front and rear ends of the poles. The ends are 
made fast to the saddles by notches, into which the fastening 
ropes are securely tied. 

AMBULANCE DRILL. 

127. The regulation ambulance provides transportation for 
eight men sitting, or two lying. As prepared for the road it 
should contain two closed litters beneath the seats, with spare 
litters outside, and four seats for two occupants apiece. 

128. The litters are said to be packed when they are closed 
and placed beneath the seats, canvas up. The seats are said 
to be prepared when they are horizontal with the leg-irons 
resting on the floor-plates ; and packed when they are hooked 
against the sides of the wagon. 

129. To take posts at tlic ambulance, the squad is marched 
to the ambulance preferably by columns of flies, and when 
within a short distance of it the commands are given : 

At ambulance. Posts, 

when No. 1 takes post on the left, No. 2 in the centre, and 
No. 3 on the right of the rear of the ambulance and close to 
it, No. 4 on the right of No. 3. 

130. This is the invariable position of the squad at ambu- 
lance, posts ; and when disarranged, from whatever cause, it 
may be reassembled by these commands for service at the 
ambulance. 

TO PREPARE SEATS. 

131. The ambulance having litters and seats packed, to 
prepare seats : 

The ambulance being at a halt and the squad at ambulance 
posts, the commands are given : 

Prepare, Seats. 

Nos. 1 and 3 raise the curtain if necessary and open the 
tail-gate : Nos. 2 and 3 enter the ambulance, No. 2 facing the 



AMBULANCE DRILL 28l 

front, and No. 3 the rear seat of their respective sides. Each 
man seizes the lower edge of the seat about six inches from 
the ends with both hands, and lifts it carefully to free the 
hooks from the upper slots, and then slips them into the lower 
slots ; he raises the legs and adjusts them to the seat which 
he tries for firmness before leaving it. He then prepares in 
like manner the other seat of his side. 

132. When the seats are prepared, No. 2 leaves the ambu- 
lance, but No. 3 remains, unless otherwise directed, until he 
has stowed such baggage as may be passed to him by the 
other bearers ; they now resume their places at ambulance 
posts. 

TO PACK SEATS. 

133. The ambulance being at a halt and the squad at 
ambulance posts, the commands are : 

Pack, Seats. 

Nos. 1 and 3 raise the curtain, open the tail-gate, and each 
removes the litter on his own side, laying it on the ground 
two yards in rear; Nos. 2 and 3 enter the ambulance. No. 2 
facing the front, and No. 3 the rear seat of their respective 
sides. Each man holds the seat with one hand and folds the 
leg-irons with the other ; then seizing the front of the seat 
with both hands, he raises the seat to clear the hooks from 
the lower slots and slips them into the upper slots. He then 
packs in like manner the other seat of his side. 

134. As soon as the seats are packed the bearers resume 
their places at ambulance posts. 

135. Should it be necessary to pack seats while the ambu- 
lance is in motion, the tail-gate is opened, Nos. 2 and 3 enter, 
pass out the litters to Nos. 1 and 4, respectively, and pack 
the seats as described. 

TO LOAD THE AMBULANCE. 

136. The litter being lifted, at the commands : 

Take post to load ambulance, March, 
the squad proceeds to the ambulance, and when one yard 



282 



EMERGENCIES AND ACCIDENTS 



from the rear step, halts and faces the litter about, so that 
the head of the patient is towards the rear of the ambulance, 
and then lower it. 

137. At the command : 

Prepare to load, 

Nos. 2 and 3 face about (toward the ambulance) and Nos. 
1 and 4 face the litter; No. 3 steps outside of his right 







It - 


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|4 




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I Br 












IX si 


rIJ|>£ 


-M 


fe 




* ,;:; '.i'\- 







Fig 173. — Loading the ambulance. 

handle and faces the litter. No. 2 remains between the rear 
handles, and No. 1 takes post outside the left handle opposite 
No. 3 and facing him, while No. 4 opens tile tail-gate and 
sees that the ambulance is in suitable condition for the recep- 
tion of the patient. If he requires assistance, No. 1 should 
render it. 

At the command : 

Load, 

'the three bearers, Nos. 1, 2, and 3, stoop, grasp their respec- 
tive handles, and slowly raise the litter to the level of the 
floor of the ambulance and advance to it, being careful to 



AMBULANCE DRILL 283 

keep the litter in a horizontal position ; the legs are placed 
on the floor by Nos. 1 and 3 and the litter pushed in by 
No. 2, assisted by the others. When this is accomplished, 
Nos. r, 2, and 3 are in position at ambulance posts, No. 1 on 
the left, No. 2 in the centre, and- No. 3 on the right, facing 
the rear of the ambulance and close to it. Nos. 1 and 3 
fasten the tail-gate ; No. 4 places in the forward compart- 
ment the arms and accoutrements of the patient (if any) and 
then takes his position on the right. After this No. 1, having 
seen that everything is secure, faces the men about and 
marches them off to continue the drill by bringing up another 
loaded litter, returning to unload, etc. 

TO UNLOAD THE AMBULANCE. 

138. The squad having been brought to ambulance posts, 
the order is given : 

Prepare to unload, 

when Nos. 1 and 3 open the tail-gate and No. 2 lays hold of 
the projecting handles. At the command: 

Unload, 

No. 2 draws out the litter, Nos. 1 and 3, facing inward, sup- 
port the poles until the front handles are reached. The 
litter, carefully supported in a horizontal position, is then 
lowered with the head of the patient one yard in rear of the 
wagon ; No. 4 closes the tail-gate, and all take position at 
litter-posts. The litter is then lifted and carried in the 
required direction. 

139. At the conclusion of the drill with ambulances the 
detachment is reformed in line of litters as in par. 63. 



Part IV 

THE CARE OF THE HUMAN MACHINE 



CHAPTER XXIX 
SANITARY SUGGESTIONS 

The human body resembles other machines in requiring 
proper care to maintain it in good order. It must be suitably 
housed and protected, the effects of wear and tear must be 
removed and harmful extraneous matters must not be per- 
mitted to reach it, it must be kept clean and sufficient power- 
producing matter or fuel must be provided for it. 

Dwellings. — For privacy and protection, man is accus- 
tomed to build for himself shelters varying in extent from 
the wickyup of the savage to the palace of the prince. By so 
doing he introduces a fruitful source of disease. The con- 
finement of the air within the walls of a dwelling compels it 
to be breathed repeatedly until, by the extraction of all of its 
nourishing elements and the pollution derived from the em- 
anations of living bodies, it is not only no longer capable of 
supporting life, but is a direct cause of death. The process 
of supplying fresh air to dwellings is called ventilation. 

Ventilation. — The reasons for the necessity of an abun- 
dant supply of fresh air have already been considered (pages 
69 and 70). Ventilation is usually accomplished by the flow 
of air in and out of doors and windows. More than seven 
per cent of carbonic acid in the air is injurious, and rooms 
should be of a sufficient size to permit the constant introduc- 
tion of enough fresh air and the prompt removal of enough 
contaminated air to keep the percentage continually below 
this point without the production of a draught. This can be 
accomplished by limiting the number of well persons in a 
room to such a degree that each one shall have about 800 
cubic feet of air-space, or a portion measuring nine feet in 
each direction ; in this case the entire bulk of air would need 
to be renewed but once in twenty minutes, which can readilv 

287 



288 THE CARE OF THE HUMAN MACHINE 

be accomplished by the ordinary means of doors and win- 
dows. In case of the sick, the requisite air space is double 
the amount named. 

The presence of foul air in dwellings — whether due to the 
breath of persons crowding a room or to other causes — is a 
fertile source of certain diseases, such as consumption, mala- 
rial affections, typhoid and typhus fevers, and the like. For 
this reason homes should not only be provided with proper 
ventilation, but swampy surroundings, foul cellars, cesspools 
or pools formed by accumulations of slops, uncared-for water- 
closets, and sewer openings should be avoided as far as 
practicable and, when existing, should be rendered as harm- 
less as possible by disinfection. 

Disinfection. — Certain agents, when applied to disease- 
inducing matters, destroy their power. These agents are 
disinfectants* and the process of applying them is disinfection. 

The term disinfectant has popularly been applied to agents 
which counteract offensive odors — deodorizers — or arrest 
decay — antiseptics. This is an error, for many of these 
agents are entirely without effect upon disease germs. A 
large number of the proprietory " disinfectants " advertised 
in the public press are of this character. 

The more valuable agents for disinfection are four in number : 

i . Heat. — A temperature elevated to the boiling-point or 
higher is the most efficient of disinfectants ; it is also a deo- 
dorizer and an antiseptic. Boiling for half an hour destroys 
germs of the greatest vitality. Infected materials, which will 
not be harmed by it, may be treated either in this way or by 
the application of superheated steam. 

2. Corrosive Sublimate. — Known also as bichloride of 
mercury, this is the most powerful chemical germicide, and 
consequently, for purposes where heat is not practicable, the 
most efficient germicide known. 

For Disinfection of Clothing. — Four ounces should be 
dissolved in a gallon of water, with one drachm of 
permanganate of potassium. The clothing must be 
thoroughly soaked in this solution for at least two hours, 
after which it may be laundered in the ordinary way. 



DISINFECTION AND DISINFECTANTS 289 

For Disinfection of Other Infections Matter. — Two 
drachms each of corrosive sublimate and permanganate 
of potassium should be dissolved in a gallon of water. 

3. Chloride of Lime. — Popularly known as "bleaching 
powder," this agent is especially useful in disinfecting the 
discharges from the body or foul soil of any kind. It is also 
a deodorant. 

For Ordinary Disinfection. — One part of chloride of 
lime with nine parts of dry earth is an excellent dis- 
infectant sprinkled copiously into privy vaults, cess- 
pools, etc. 

For Disinfection of Infections Matter. — Four ounces of 
chloride of lime dissolved in a gallon of water form 
a solution into which should be passed the discharges 
from cholera, typhoid fever, and other affections hav- 
ing discharges of an infectious character. 

4. Sulphur. — Sulphur may be used in the form of roll 
sulphur or brimstone or cast into sulphur candles. The 
disinfecting element is sulphurous acid gas, which is liberated 
by burning. To get the effect of this agent, every aperture 
in a room must be tightly closed to prevent its escape, and 
three pounds of sulphur used for every thousand cubic feet of 
air-space. The sulphur should be broken into small pieces 
and moistened with alcohol before lighting. To obviate the 
danger of fire, it should be placed in a shallow iron pan set 
upon a couple of bricks in a tub partly full of water. After 
twenty-four hours the doors and windows should be thrown 
wide open to permit the sulphurous acid gas to be blown out. 

The stools in cholera and typhoid fever, and probably in epidemic 
dysentery, consumption, diphtheria, and yellow, scarlet, and typhus fevers 
are infectious. The vomited matter in cholera, diphtheria, and yellow 
and scarlet fevers is liable to convey infection ; and the expectoration 
of consumption, diphtheria, scarlet fever, and infectious pneumonia is 
similarly dangerous. They should all then be discharged into vessels 
containing enough corrosive sublimate or chloride of lime solution to 
cover them. 

Clothing contaminated by small-pox, scarlet fever, and other con- 
tagious diseases may be disinfected by immediately boiling it or by 
soaking it in a corrosive sublimate solution. But clothing and bedding 



29O THE CARE OF THE HUMAN MACHINE 

too bulky, or otherwise unsuited to such treatment, should be burned 
without delay. 

During the occupation of a room by a subject of infectious disease 
it cannot be disinfected except by free ventilation, — removing the con- 
taminated and introducing fresh air. To render this easier, the carpets, 
pictures, hangings, and all unnecessary furniture should be removed 
when the room is given to the patient. 

After the removal from a room, by death or recovery, of a subject of 
infectious disease, the walls, ceiling, and floor should be washed with a 
solution formed by the addition of a 'pint of the stronger corrosive 
sublimate solution to four gallons of water. All woodwork should be 
scrubbed with soap and water. After this the room may also be fumi- 
gated with sulphur. 

Centres of putrefaction, such as cesspools, drains, and privy vaults 
may be treated with the weaker sublimate solution, or with chloride of 
lime in solution, or in powder, as may be convenient. 

Food and drink are readily and infallibly disinfected by cooking. 
Boiling or roasting for half an hour destroys the most active germs. 
In case of an epidemic of cholera or typhoid fever, nothing should be 
taken into the stomach that has not been so treated. 

Deodorization. — As already remarked, certain agents are 
of value in overcoming offensive odors, although not useful 
as disinfectants. 

Dry earth, wood ashes, and powdered charcoal belong to 
this class, and are to be applied by free'sprinkling. 

Chloride of zinc, an ounce dissolved in a quart of water, is 
an effective deodorant. 

Chloride of lime, in solution and in powder, belongs to 
both classes. 

Cleanliness. — Nothing is a more efficient preventive of 
sickness than cleanliness of person, habitation, and surround- 
ings. Filth of every kind is a most favorable soil for the 
culture of disease. The surroundings of a dwelling, then? 
should be carefully cleaned, no piles of decaying matter — 
either vegetable or animal — being permitted. That the 
house itself should be kept clean goes without saying. 

The skin throws off every day two or three pounds cf ex- 
crementitious matters, both solid and liquid, and to insure its 
proper action, they must be removed. If they are permitted 
to remain, decomposition soon sets in, and the skin is then 



CLEANLINESS AND CLOTHING 2gi 

covered with a layer of decaying matter which closes the 
pores and paves the way for much ill-health. When practi- 
cable, then, the entire person should be bathed daily with 
fresh water, or. better, with a solution of an ounce of car- 
bonate of soda to the gallon of water. 

Clothing. — The prime object of clothing being the pro- 
tection of the body from the harmful action of atmospheric 
heat, cold, and moisture, it follows that the clothing should 
be modified from time to time to suit the weather. The mate- 
rials should vary in weight, texture, and character, according 
to the season and the latitude, since both extremes of bodily 
temperature are equally dangerous to health. The fit of the 
clothing is of importance, for ill-fitting clothing is apt to be 
chafing to the body as well as to the spirit. 

Chafing occurs chiefly in the bends of the joints, such as 
the armpits, elbows, and knees, and between the thighs, but 
it may appear at any point where the clothing rubs the skin. 
The chafed parts should be carefully washed with soap and 
water and thoroughly dried ; they may then be dusted with a 
suitable bland powder, such as magnesia, fullers earth, and 
even starch, meal, or flour, although the latter are objection- 
able on account of their liability to form with the perspira- 
tion a sour and irritating paste. 

Foot-soreness is chiefly due to ill-fitting shoes, although it 
may arise from other causes. It is a common complaint in 
marching. Soaking in hot salt water, or alum and water, the 
night before is said to reduce the liability to foot-soreness. 
Rubbing the feet with grease of any kind before starting is 
an advantage. In the German army there is sifted into the 
shoes and stockings, to prevent trouble with the feet, a pow- 
der composed of three parts by weight of salicylic acid, ten 
of starch, and eighty-seven of powdered soapstone. Blisters 
should be opened at the end of the march by pricking at 
either end and gently pressing the fluid out of the openings, 
taking care not to break the skin. Where the difficulty is 
due to inflamed corns, bunions, or ingrowing toenail, the 
surgeon should apply the treatment. 



292 



THE CARE OF THE HUMAN MACHINE 



Food. — The food forms an important part of the fuel of 
the human machine. The more easy the digestion, — the 
process of extracting the portions of the fuel utilizable in 
the machine, — the more easily the machine runs-. The fol- 
lowing table, showing comparatively the time required for 
the digestion of some of the more common articles of diet, 
may serve as a guide to the selection of food for the body — 
fuel for the machine : — 



Rice, Boiled 
Tripe, Boiled 

Eggs, Uncooked 
Tapioca 
Barley or Sago 
Milk, Boiled 
Codfish 

Turkey, Roast 
Lamb, Roast 
Beans 
Potatoes 



1 hour. 



2 hours. 



25 hours. 



Beef, Roast 
Mutton, Roast 
Oysters 
Eggs, Soft 

Bread 
Butter 
Cheese 
Eggs, Hard 
Eggs, Fried 

Duck 
Chicken 

Veal, Roast 
Pork, Roast 



1 

} 3 hours. 

33 hours. 

[ 4 hours. 
[ 4! hours. 



The amount of food required to maintain a healthful exist- 
ence varies according to the individual and his occupation. 
Physiologists have carefully worked out the proportion of the 
various elements required for this purpose. The ration of 
the United States soldier, while not absolutely complete as 
a dietary, perhaps approaches as nearly the amount needed 
daily by a healthy man as may be required. It contains — 

Fresh beef or other fresh meat . . . . 20 oz. 

or Salt beef 22 

or Salt pork or bacon, or canned beef 

Potatoes 

or Potatoes | 
and Onions j 

or Potatoes ) 

and Tomatoes (or other vegetables in cans) j 

Sugar 

Salt 



12 



16 
12.8 
3- 2 
II. 2 

4.8 

2.4 

.64 



FOOD 



293 



Pepper . 

Flour 
or Soft bread 
or Hard bread 
or Corn meal 

Beans or peas 

Rice or hominy 

Coffee, green 
or Coffee, roasted 
or Tea 

Vinegar . 

Soap 



.04 oz. 
18 
18 
16 
20 
2.4 
1.6 
1.6 
1.28 
.32 

.04 qt. 
.48 oz. 



Where illuminating oil is not furnished, .24 oz. candles ; and in the 
field, when necessary, .48 oz. yeast powder. 

Of equal if not greater importance than the amount of 
food is its proper preparation. As has been remarked in 
connection with the sense of taste, the rendering food savory 
and digestible, and serving it in a tempting manner, is a study 
worthy the attention of a higher grade of talent than is ordi- 
narily devoted to it. Recent experiments by Edward Atkin- 
son have shown that the art of cookery is still in its infancy. 
It is impossible, however, within the limits of this Manual to 
do more than to call attention to the deficiency and to urge 
a more general attention to the subject. 



INDEX 



INDEX 



Accidents, how to act in, 119. 
Acid, prussic, poisoning by, 229. 
Acids, poisoning by, 227. 
Aconite poisoning, 229. 
Adam's apple, 16. 
Adipose tissue, 6. 
Air supply, 287. 
Alimentary canal, 70. 
Alkalies, poisoning by, 227. 
Almonds, bitter, poisoning by oil 

of, 229. 
Ambulance corps, 238. 
Ambulance station, 241. 
Ammonia poisoning, 227. 
Anatomy of man, see Human ma- 
chine, 1. 
Antisepsis, 89, 90. 
Antiseptic surgery, 107. 
Apoplexy, 204. 

Aqua fortis, poisoning by, 227. 
Arm, bleeding from arteries of, 155 ; 
broken, 183 ; slings for, 95, 
103; triangular bandages for, 
98. 
Army, first-aid organization, 236. 
Arteries, 52. 

and veins, difference between, 57. 

bleeding from, 146. 

of body, bleeding from, 158. 

of elbow, bleeding from, 157. 

of foot, bleeding from, 161. 

of forearm, bleeding from, 157. 

of hand, bleeding from, 158. 

of head, bleeding from, 153. 

of knee, bleeding from, 160. 

of leg, bleeding from, 161. 

of lower extremity, bleeding from, 
158. 

of neck, bleeding from, 154. 

of thigh, bleeding from, 160. 

of upper extremity, bleeding from, 
155. 



Arteries, principal, 57. 

pulmonary, 66. 
Arrows and fish hooks, 141. 
Arsenic poisoning, 228. 
Ash berries, poisoning by moun- 
tain, 229. 
Asphyxia, 214. 
Atropia poisoning, 229. 

Bacilli, 87. 

Back, triangular bandage for, 97. 

Bacteria, 87. 

Bandage, arm sling, roller, 103. 

double-headed roller, 106. 

four-tailed, 101. 

hardened, 106. 

method of rolling a, 103. 

roller, 101. 

square, 100. 

triangular, 93. 

turns and reverses, 104. 
Battle-field, emergencies of, 236. 
Bearers, company, 236. 
Belladonna poisoning, 229. 
Berries, poisoning by, 229. 
Bites, dog, 232. 

insect, 233. 

snake, 233. 

tarantula, 233. 
Bittersweet berries, poisoning by, 

229. 
Black-heads, 4. 
Bladder, 78. 
Bleeding, 145. 

from arteries, treatment of, 149. 

of body, 158. 

of elbow, 157. 

of foot, 161. 

of forearm, 157. 

of hand, 158. 

of head, 153. 

of knee, 160. 

297 



298 



INDEX 



Bleeding, of leg, 161. 

of lower extremity, 158. 

of neck, 154. 

of thigh, 160. 

of upper extremity, 155. 

from the nose, 166. 

from wounds of capillaries, 163. 

from wounds of veins, 162. 

internal, 167. 

secondary, 167. 

special susceptibility to, 168. 
Blood, 46. 

circulation of, 54. 

clotting, 48. 

corpuscles, 47. 

functions of, 49. 

spitting of, 164. 
Blood-vessels, 52, 57. 
Body, bleeding from arteries of, 158. 
Bones, 6, 10. 

ankle, 23. 

arm, 18. 

arm, broken, 183. 

back, 14. 

breast, 17. 

broken, 172. 

carpus, 20. 

cheek, 12. 

chest, 16. 

clavicle, 18. 

coccyx, 15. 

collar, 18. 

collar, broken, 182. 

femur, 22. 

fibula, 23. 

fingers, 20. 

fingers, broken, 186. 

foot, 24. 

foot, broken, 191. 

forearm, 19. 

forearm, broken, 184. 

hand, 20. 

hand, broken, 186. 

hip, 21. 

humerus, 18. 

hyoid, 16. , 

innominate, 21. 

instep, 24. 

jaw, 12, 13. 

jaw, broken, 181. 

knee-cap, 23. 

knee-cap, broken, 190. 

lachrymal, 12. 



Bones, leg, 23. 

leg, broken, 190. 

malar, 12. 

malleolus, 23. 

maxillary, 12. 

nasal, 12. 

nose, broken, 181. 

occipital, 11. 

palate, 12. 

patella, 23. 

pelvic, 21. 

pelvic, broken, 188. 

radius, 19. 

ribs, 16. 

ribs, broken, 187. 

rump, 15. 

sacrum, 15. 

scapula, 17. 

sesamoid, 9. 

shoulder blade, 17. 

shoulder blade, broken, 183. 

skull, broken, 180. 

sphenoid, 11. 

spinal, 14. 

spinal, broken, 186. 

sternum, 17. 

teeth, 12. 

temporal, 11. 

thigh, 22. 

thigh, broken, 188. 

thorax, 16. 

tibia, 23. 

ulna, 19. 

wormian, 9. 

wrist, 20. 

wrist, broken, 185. 
Bowels, 73, jj. 
Brain, 36. 

compression of, 203. 

concussion of, 201. 

membranes, 43. 

structure, 41. 
Breath, 288. 

nourishment from, 69. 

poison in, 69. 
Breathing, 67. 

and speaking apparatus, 64. 

indications of different kinds of, 
124. 

restoring the, 215, 218. 
Broken bones, 172. 
Bronchial tubes, 66. 
Bruises, 125. 



INDEX 



299 



Burning clothing, 130. 
Burns, 127. 

Callosities, 4. 
Calomel poisoning, 228. 
Capelline bandage, 106. 
Capillaries, 53. 

bleeding from, 148. 

bleeding from wounds of, 163. 
Carbonic acid in breath, 69. 
Cartilages, 16, 17, 28. 
Caustic poisoning, 227. 
Centipede sting, 233. 
Cerebellum, 37. 
Cerebrum, 37. 
Chafing, 291. 
Chest, 16, 66. 

triangular bandage for, 97. 

wounds of, 141. 
Chilblains, 132. 
Chloral poisoning, 228. 
Chloride of lime as a disinfectant, 

289. 
Choking, 195. 
Circulation of blood, 54. 
Clavicle, fracture of, 182. 
Cleanliness, 290. 
Clothing, 291. 
Clove hitch, 92. 
Collar bone, broken, 182. 
Company bearers, 236. 
Compression of brain, 203. 
Concussion of the brain, 201. 
Contagious disease, disinfection in, 

290. 
Contusions, 125. 
Convulsions, 211. 
Copper poisoning, 228. 
Copperas poisoning, 228. 
Corda dorsalis, 9. 
Corrosive sublimate as a disinfect- 
ant, 288. 

poisoning, 228. 
Coughing, 68. 
Cranium, 9. 
Cuts, see Wounds. 
Cyanide of potash, poisoning by, 
229. 

Death, 234. 

proofs of, 235. 
Deodorization, 290. 
Dermis or true skin, 4. 



Digestion of food, 292. 

process of, 75. 
Digestive apparatus, 70. 
Disabled, carrying, 243. 
Diseases, indications of, 123. 
Disinfection, 288. 
Dislocations, 169. 
Dizziness, 124. 
Dog bites, 232. 
Dressings, 107. 
Dressing packet, first, 109. 
Dressing station, first, 240. 
Drill, ambulance, 283. 

bearer, 244. 

litter, 250. 
Drowning, resuscitation from, 217. 

rescuing the, 221, 223. 
Drunkenness, 206. 
Dwellings, hygiene of, 287. 

» 

Ears, 80. 

foreign body in, 193. 
Elbow, bleeding from arteries of, 

157. 

broken, 184. 

roller bandage for, 105. 

triangular bandage for, 99. 
Emergencies, how to act in, 119. 
Emetics, 230. 
Endosteum, 8. 
Epidermis, or scarf-skin, 3. 
Epilepsy, 211. 
Esmarch's bandage, 193. 
Excretion, apparatus for, 76. 
Examination of an injured person, 

122. 
Eye, 82. 

foreign body in, 192. 

Face, see Black-heads.^ 

bones of, 9. 

triangular bandage for, 97. 
Fainting, 196, 198. 
Falling sickness, 211. 
Fat, 5. 

Femur, broken, 188. 
Fevers and infection, 288. 
Fibula, broken, 190. 
Fingers, broken, 186. 

dislocations of, 170. 

roller bandage for, 105. 
First-dressing packet, 109. 
Fish-hooks and arrows, 141. 



300 



INDEX 



Fits, 211. 

children's, 213. 

epileptic, 211. 
Fomentations, 114, 115. 
Fontanelles, 9, 11. 
Foods, digestion of, 70. 

hygiene of, 292. 

ration of the soldier, 292. 
Foot, bleeding from arteries of, 161. 

broken, 191. 

roller bandage for, 105, 106. 

triangular bandage for, 100. 
Foot-soreness, 291. 
Forearm, bleeding from arteries of, 

157- 

broken, 184. 

roller bandage for, 105. 

triangular bandage for, 99. 
Foreign body in the ear, 193. 

in the eye, 192. 

in the nose, 194. 

in the throat, 195. 
Fowler's solution, poisoning by, 

228. 
Fracture, 172. 

at elbow, 184. 

at wrist, 185. 
Fracture, compound, 173. 

in the hand, 186. 

of arm, 183. 

of collar bone, 182. 

of fingers, 186. 

of foot, 191. 

of forearm, 184. 

of jaw, 181. 

of knee-cap, 190. 

of leg, 190. 

of nose, i8r. 

of pelvis, 188. 

of ribs, 187. 

of skull, 180. 

of spine, 186. 

of thigh, 188. 

simple, 173. 
Freezing, 131. 

insensibility from, 210. 
Frostbite, 131. 

Gases, smothering by, 223. 

Gauze for dressings, 107. 

Geneva Convention, provisions of, I 

239. 
Germicides, 89, 90. 



Germs, 87. 
Glands, salivary, 71. 

sebaceous, 4. 

sweat, 4. 

vascular, 64. 
Granulations, 144. 
Green coloring-matter, poisoning 
by, 228. 

Paris, poisoning by, 228. 

vitriol, poisoning, 228. 
Gunshot wounds, 141. 
Gullet, 71. 
Guts, 73. 

Hair, nails, and warts, 4. 
Hand, bleeding from arteries of, 
158. 
broken, 186. 
roller bandage for, 105. 
4 triangular bandage for, 99. 
I Hanging, smothering by, 225. 
Head, bleeding from arteries of, 

153- 

bones of, 9. 

four-tailed bandage cap for, 101. 

roller bandage for, 106. 

square bandage for, 100. 

triangular bandage for, 96, 97. 
Healing in wounds, 144. 
Hearing, 80. 
Heart, 50. 

Heat as a disinfectant, 288. 
Heatstroke, 207. 
Hellebore poisoning, 229. 
Hemlock poisoning, 229. 
Hemorrhage, 145. 

from the lungs, 165. 

secondary, 167. 
Hiccup, 68. 
Hip, roller bandage for, 100. 

triangular bandage for, 99. 
Hip-bones, 21. 

broken, 188. 
Hitch, clove, 92. 
Horse-chestnut poisoning, 229. 
Horseback, loading patient on, 280. 
Horse-litters, 282. 
Hospital corps, 237. 

field, 242. 

stewards, 237. 
acting, 237. 
Human machine, 1. 
Humerus, fracture of, 183. 



INDEX 



301 



Hunchback, cause of, 15. 
Hygiene, 287. 
Hysterics, 212. 

Ice, breaking through, 223. 

Indian tobacco, poisoning by, 229. 

Inebriation, 206. 

Injured, carrying the, 243. 

Insolation, 207. 

Inspection of hospital corps, 247. 

Instep, 24. 

Intestines, 73. 

Intoxication, 206. 

Iron, poisoning by, 228. 

Ivy poisoning, 230. 

Jamestown weed, poisoning by, 

229. 
Jaw, broken, 181. 

dislocation of lower, 171. 
Joints, see Sprains, 8, 25. 

dislocations of, 169. 

Kidneys, 77. 

Knee, bleeding from arteries of, 
160. 

roller bandage for, 106. 

triangular bandage for, 100. 
Knee-cap, broken, 190. 
Knot, clove-hitch, 92. 

false, 91. 

granny, 91. 

reef, 91. 

square, 91. 

surgeon's, 92. 

Larynx, 65. 

Laudanum poisoning. 228. 

Laurel water poisoning, 229. 

Lead poisoning, 229. 

Leg, bleeding from arteries of, 161. 

broken, 190. 

roller bandages for, 106. 

triangular bandage for, 100. 
Lettuce, wild, poisoning by, 229. 
Ligaments, 26. 

Lime chloride as a disinfectant, 289. 
Litter, U. S. army, 243. 
Litter-drill, 250. 
Lever, 74. 

Lunar caustic, poisoning by, 227. 
Lungs, 66. 

action in excretion, 77. 



Lungs, hemorrhage from the, 165. 
Lye poisoning, 227. 

Matches, poisoning by, 229. 
Medical officers, 236. 
Medulla oblongata, 42. 
Mercuric bichloride as a disinfect- 
ant, 288. 
Microbes, 87. 
■Micro-organisms, 87. 
Morphine poisoning, 228. 
Mouth, 65. 

action on food in, 71. 
Mumps, 71. 
Muscles, 29. 

description of, 35. 

involuntary, 31. 

movements of, 30. 

voluntary, 30, 31. 
Mushrooms, poisoning by, 229. 
Mustard plaster, 116. 
Muster of hospital corps, 249. 

Xails, warts, and callosities, 4. 
Neck, bleeding from arteries of, 

154- 

triangular bandage for, 97. 
Nerves, 36. 

cells, 41. 

cranial, 39, 43. 

location of principal, 44, 45. 

motor, 40. 

sensory, 40. 

sympathetic, 45. 
Nightshade, deadly, poisoning by, 

229. 
Nose, 80. 

broken, 181. 

foreign body in, 194. 
Nosebleed, 166. 
Nux vomica, poisoning by, 229. 

Odors, to overcome offensive, 290. 
(Esophagus, 71. 
Ointments, 112. 
Opium poisoning, 228. 
Oxygen in breath, 69. 

Packet, first-dressing, 109. 
Pancreas, 75. 
Paralytic stroke, 204. 
Paregoric poisoning, 228. 
Parsley, poisoning by wild, 229. 



302 



INDEX 



Patella, broken, ico. 
Pelvis, 21. 

broken, 188. 
Perceptive apparatus, 79. 
Periosteum, 8. 
Pharynx, 65. 
Physiology of man, see Human 

machine. 
Phosphorus poisoning, 229. 
Plaster, court, 112. 

mustard, 116. 

sticking, 112. 
Poke berries, poisoning by, 229. 
Poisoned wounds, 231. 
Poisoning, treatment of, 226. 

acids, 227. 

aconite, 229. 

alkalies, 227. 

ammonia, 227. 

aqua fortis, 227. 

arsenic, 228. 

atropia, 229. 

belladonna, 229. 

berries, 229. 

bittersweet berries, 229. 

blue vitriol, 228. 

calomel, 228. 

caustic, 227. 

chloral, 228. 

copper, 228. 

copperas, 228. 

corrosive sublimate, 228. 

cyanide of potash, 229. 

Fowler's solution, 228. 

green coloring-matter, 228. 

green, Paris, 228. 

green vitriol, 228. 

hellebore, 229. 

hemlock, 229. 

horse-chestnut, 229. 

Indian tobacco, 229. 

insensibility from, 209. 

iron, 228. 

ivy, 230. 

Jamestown weed, 229. 

laudanum, 228. 

laurel water, 229. 

lead, 229. 

lettuce, wild, 229. 

lye, 227. 

matches, 229. 

mercury, 228. 

morphine, 228. 



Poisoning, mountain ash berries, 
229. 

mushrooms, 229. 

nux vomica, 229. 

oil of bitter almonds, 229. 

opium, 228. 

paregoric, 228. 

parsley, wild, 229. 

poke berries, 229. 

phosphorus, 229. 

potash, 227. 

prussic acid, 229. 

rhubarb leaves, 229. 

rhus, 230. 

rough on rats, 228, 

Scheele's green, 228. 

sleeping mixture, 228. 

soda, 227. 

strychnia, 229. 

sumac, 230. 

toadstools, 229. 

tobacco, 229. 

verdigris, 228. 

vermilion, 228. 

vitriol, 227. 
Potash poisoning, 227. 
Pouitices, 113. 
Pressure on chest, smothering by, 

225. 
Pronation, 19. 

Prussic acid poisoning, 229. 
Pulse, 56. 

indications of the, 124. 

Radius, fracture of, 184. 
Ration of the soldier, 292. 
\ Rectum, 76, 77. 
Respiration, 67. 

artificial, 215, 218. 
' Rhubarb poisoning, 229. 
Rhus poisoning, 230. 
Ribs, 16. 

broken, 187. 

triangular bandage for, 98. 
Roller bandage, 101. 

double-headed, 106. 
Rough on rats, poisoning by, 228. 

Saliva, 71. 
Salves, 1 1 "2. 
Sanitary soldiers, 237. 

suggestions, 287. 
Scapula, fracture of, 183. 



INDEX 



303 



Scheele's green, poisoning by, 228. 

Scorpion sting, 233. 

Senses, 79. 

Shock, 199. 

Shoulder, dislocation of, 171. 

roller bandage for, 105. 

triangular bandage for, 98. 
Shoulder blade, broken, 183. 
Sighing, 68. 
Sight, 81. 

defective, 83. 
Singing, 68. 
Skeleton, see Bones. 
Skin, 3. 

action in excretion, 76. 

appendages of, 4. 

scarf, 3. 

true, 4. 
Skull. 9. 

broken, 180. 
Sleeping-mixture poisoning, 228. 
Slings for broken bones, 179. 

roller bandage arm, 103. 

triangular bandage for, 95. 
Smell, 80. 

Smells^to overcome offensive, 290. 
Smothering, 214. 

by gases, 223. 

by hanging, 225. 

by pressure on chest, 225. 

by strangling, 225. 
Snake bites, 233. 
Sneezing, 68. 
Soldiers, sanitary, 237. 
Spanish windlass tourniquet, 151. 
Speaking, 68. 

and breathing apparatus, 64. 
Spica turn of bandage, 105. 
Spinal column, 14. 

cord, 43. 
Spine, broken, 186. 
Spiral turns of bandage, 104. 
Spitting of blood, 164. 
Splinters, 140. 
Splints, 176. 
Sprains, 169. 
Stewards, hospital, 237. 
Stings, insect, 233. 
Stomach, 71. 

Strangling, smothering by, 225. 
Stroke, paralytic, 204. 

sun, 207. 
Strychnine poisoning, 229. 



Stunning, 201. 

Suffocation, 214. 

Sulphur as a disinfectant, 289. 

Sumac poisoning, 230. 

Sunburn, 130. 

Sunstroke, 207. 

Supination, 19. 

Surgeons, military, 236. 

Sweetbreads, 75. 

Swooning, 198. 

Symptoms, 123. 

Syncope, 198. 

Synovial membrane, 27. 

Tarantula bite, 233. 
Taste, 79. 
Teeth, 12. 
Tendons, 33. 

Thigh, bleeding from arteries of, 
160. 

broken, 188. 

roller bandage for, 106. 

triangular bandage for, 100. 
Thorax, 16. 

Throat, foreign body in, 195. 
Tibia, broken, 190. 
Toadstools, poisoning by, 229. 
Tobacco poisoning, 229. 
Travois, 281. 
Tongue, 80. 
Touch, 79. 
Tourniquets, 151. 
Transportation of disabled, 243, 

Ulna, fracture of, 184. 
Unconsciousness, 196. 

Veins, 53. 

and arteries, difference between, 

57- 

bleeding from, 147. 

bleeding from wounds of, 162. 

principal, 62. 

pulmonary, 66. 
Ventilation, 287. 

necessity for, 70. 
Verdegris poisoning, 228. 
Vermilion poisoning, 228. 
Vitriol, blue, poisoning by, 228. 

green, poisoning, 228. 

poisoning, 227. 
Vocal cords, 65. 
Voice, production of, 65. 



3°4 



INDEX 



Vomking, methods of producing, 


Wounds, dressings for, 107. 


230. 


gunshot, 141. 




healing of, 144. 


Warts, nails, hair, 4. 


of arteries, bleeding from, 149. 


Waste, apparatus for disposal of, 


of capillaries, bleeding froiu, 163 


176. 


of chest, 141. 


Wens, 4. 


of veins, bleeding from, 162. 


Windpipe, 66. 


pierced or punctured, 139. 


Wounded, carrying the, 243. 


poisoned, 231. 


Wounds, 133. 


torn or lacerated, 139. 


cleansing, 135. 


triangular bandage for, 96. 


closing, 135. 


Wrist, broken, 185. 


danger of, 143. 


roller bandage for, 105. 


dressing, 138. 


triangular bandage for, 99. 



Typography by J. S. Cushing & Co., Boston, U.S.A. 
Presswork by Berwick & Smith, Boston, U.S.A. 



